KCUR News
12:50 am
Sun September 26, 2010

New Pre-Existing Condition Program Gets Slim Response

Kansas City, MO – High risk insurance pools are designed to cover people with preexisting health conditions who can't get coverage. Missouri recently launched a new pool, subsidized under the recently passed federal health law. The program could apply to upwards of 150,000 residents, but not many are signing up so far.

Denied Coverage
Carolen Collins says she didn't think finding insurance would be such a problem when she decided to take early retirement from KU hospital two years ago.

"I never thought - while I was working there anyway - it never occurred to me I might be someone coming through the door someday without insurance," says Collins.

The retired writer says she applied for coverage, but couldn't find a plan that would accept her. A few years ago, she had a minor spot of non-basal cell skin cancer removed. And, at age 64, Collins has diabetes.

She says she wound up enrolling in her work's COBRA plan. It ran out last winter. That was right around the time Congress passed the new federal health care law, which included the creation of new temporary high risk insurance pools. To be eligible, a person has to be uninsured for at least six months and have a chronic health problem.

Collins immediately applied for the plan and was accepted.

"I feel enormously relieved to no longer be playing that sort of high stakes insurance roulette, not knowing from day to day if something crazy might happen with a diagnosis or a serious auto accident or something like that," says Collins.

Already Existing Program
Missouri already operates a high risk pool. About 4,000 people are enrolled in it. But the new, federally subsidized program has some advantages.

The current pool has a waiting period before it covers pre-existing health conditions. Benefits in the new program kick in right away. Coverage is also cheaper. Private insurance and the existing state pool can charge people with health problems more for coverage. That's not the case with the new program.

New Program's Slim Response
John Huff directs the Missouri Department of insurance, which is overseeing the pool. He says he wasn't sure what to expect in terms of people's interest when the program started in August.

"We planned for capacity and for budgeted up to 1,000 for 2010," says Huff.

But so far, only about seventy people have enrolled - another fifty or so applications are pending. In Kansas, less than fifty have signed up.

Huff says the situation is no different from what most other states are experiencing.

"I think part of it is just awareness - again it's a very new program," he says.

Affordability Issues
The program is not cheap, either. In Missouri, premiums for an individual in the new program range - depending on age - from about $250 a month to nearly $1,000. That's too much for a lot of people, especially in this economy.

Inside the Jackson County Free Health Clinic in Independence, Dr. Bridget McCandless checks a patient's blood pressure. Unlike response to the new state pool, Dr. McCandless says the clinic is busier than ever.

"There's a lot of people who don't have health insurance," says Dr. McCandless. "Either their jobs don't offer it or they're now in between jobs and don't have access to health insurance. And we're seeing more and more people who are coming to us who have never had to ask for any type of support in the past."

That includes Cathy Ginavan. Like Collins, Ginavan also has diabetes. Several months ago, she lost her job, and with it her health coverage. She says it's been tough. Before learning about the clinic, she couldn't afford her medications. She says things got really out of control. "Since I'm diabetic my blood sugar was very high and that can lead to going into a coma," says Ginavan. "Blood pressure was high, and that can lead to going into a coma and having a stroke. Same with cholesterol - that adds to it. So it was a no win situation."

Ginavan says things are better now, but she almost wound up in the emergency room at one point. The forty eight year old says she would love to have insurance, but for someone her age, premiums in the new high risk program would cost about $600 a month.

"I wouldn't be able to pay rent or utilities," she says.

Some Benefit
The pool is still an important option, according to according to Deborah Chollet, who studies high risk pools at Mathematica Policy Research, a nonpartisan think tank. It's especially the case for people that can afford it and need coverage for a serious health problem, like cancer or a brain injury. In those situations, the cost of a health plan may be far less than what one would pay out of pocket for treatments, which can be hundreds of thousands of dollars.

But Chollet says pools are no long term fix.

"And I think the federal high risk pool recognizes this, which is why it's temporary," says Chollet. "But I don't think any high risk pool is at end of day a good substitute for access to the same insurance that healthy people have."

Meanwhile, Chollet says all of this is supposed to change in 2014. That's when the high risk pools phase out and new insurance exchanges begin. And with that, companies will no longer be able to deny people coverage or charge them more for having a pre-existing health condition.

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