On July 1, states began taking applications for enrollment in the new high risk insurance pools. These pools were established to provide coverage for people with pre-existing medical conditions which make them uninsurable under the current healthcare system. formation of these pools targets the meaningful potential of the overhaul of healthcare: everyone can get health coverage.
The response to the new pools has been modest, although Jay Angoff, director of the HHS Office of Consumer Information and Insurance Oversight states, “We’re going to do our best that it insures as many people as possible.” The reviews of the new pre-existing condition insurance plans – PCIPs have so far been mixed. The PCIPs have become a lifeline for some people, enabling them to get the treatment they need but otherwise would have gone without or paid for themselves, but other people are frustrated by the eligibility rules and the cost of premiums.
The PCIP program is the first major plank of the overhaul of health-care and it’s designed as a permanent provision to expand coverage until 2014, when the state-based health insurance exchanges are expected to be up and running. At that time anyone without affordable job-based coverage will be able to by health insurance on one of the exchanges. The PCIP program has $5 billion in funding which is for all 50 states.
There are 35 states that already had high risk pools which provided health coverage for about 200,000 people. These pools have several weaknesses, including high premiums and long waiting periods. People already in these pools cannot switch to the new PCIPs unless they drop their coverage for six months already if the premiums are cheaper. This is one of the problems with the new laws.
The new pools are slightly different from the traditional state risk pools. The premiums for older participants cannot be more than four times the premium charge for the youngest participants and the plans must also have a comprehensive range of sets. The out of pocket costs for an individual is capped at $5,950 by 2011.
For Gillian Sender, uninsured since December, the new plan is an enormous relief. When she started feeling fatigued and bloated, she went to a community health center and then was then referred to a gynecologic surgeon who diagnosed her with uterine cancer. She found out about the new PCIPs the same week she was diagnosed. Sender signed up for a plan where she pays $288 per month and has a $3,500 deductible. She is now covered for chemotherapy and radiation treatments which has been a big relief for her.
States were given the option of running their own programs or letting the federal government run them. Various estimates have suggested that the $5 billion will run out before 2014 and 27 states chose to let the federal government run the programs to avoid possibly being liable for the shortfall. Monthly premiums will range from $140 to $900, depending on a person’s age and state of residence, said Richard Popper of the HHS Office of Consumer Information and Insurance Oversight.
A recent report at the University of Kansas found a wide gap in monthly premium costs. Premiums for a 50-year-old nonsmoker ranged from a few hundred to more than $1000 per month. Premiums in the federally administered plans with a $2500 deductible averaged $455 per month. The premiums in Maryland, which operates its own plan, would be from $141 to $328 with a $1500 deductible, while in California, a resident of the San Francisco Bay area would pay $575 a month for a comprehensive policy with a $1,500 annual medical deductible and an annual maximum of $2,500 in out-of-pocket expenses. Gary Claxton, a vice president with the nonprofit Kaiser Family Foundation, said: “For someone who is low-income, they may not be able to provide it, to someone who is middle-class, it’ll nevertheless feel expensive, but it will be like other people buying health insurance on their own.”
The meaningful features of the plans vary from state to state. The variations include deductible amounts and out of pocket expenses for out of network care. Coverage for medications and preventive sets without first having to meet a deductible is another variation between states.
The new plans can be tough to get into. One of the requirements is that people need to have been uninsured for six months. Connecticut Gov. M. Jodi Rell wrote to Secretary of Health and Human sets Kathleen Sebelius to recommend reasonable exceptions to the six-month rule. People who exhaust their often called COBRA benefits after a layoff should be able to sign up. However, since the six-month requirement is part of the statute, it would require a change in the law to adjust it, say experts.
Another requirement for coverage is that applicants must present a written letter of rejection from an insurance company that refuses to cover them or their pre-existing condition. This can put people who have not been denied coverage outright in a tough identify. For people who live in a guarantee issue state where insurers are not permitted to deny coverage, applicants only need to provide proof that the premium charge they would be obligated to pay is well above the charge from the high-risk pool.
There are 23 states which run their own plans that allow people with specific health conditions such as cancer, diabetes, or stroke to qualify for the plans. Although there may be some people who will not qualify based on the eligibility criteria, a majority of those in need of health coverage will get the help they need.