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In 2008, a Harvard Medical School study found as many as 11.4 million working adults in the U.S. who suffered chronic conditions were uninsured, many of whom had forgone medical care.  -- Reuters

The high-risk health insurance pools are part of the Patient Protection and Affordable Care Act.  They are up and running now in all 50 states, and are supposed to help some of these 11.4 million people -- those insurance companies had rejected because of pre-existing conditions.  

With this large number of potentially eligible people in mind, many criticized the funding of the PPACA's high-risk insurance pools as woefully inadequate:

... government economists projected as recently as April that 375,000 people would gain coverage this year, and they questioned whether $5 billion allocated to the program would be enough... -- Associated Press

Yet, if you pay any attention at all, the stories you see go like this:

California, which has money for about 20,000 people, has received fewer than 450 applications, according to a state official.

The program in Texas had enrolled about 200 by early September, an official in that state said.

In Wisconsin... they've received fewer than 300 applications so far, with room for about 8,000 people in the program.

In Connecticut:

Coverage under the plan began Friday, with only five people enrolled.

And in Michigan:

PHP has mailed more than 1,300 applications to potential customers...
Nearly 100 people had turned in applications as of Monday, said Scott Wilkerson, PHP's president and CEO.

In fact, here in California, the program was so in need of applicants that they actually called me up to ask why I had not returned my application form (I had requested one just to see what it looked like and what the terms and conditions were, as part of my ongoing interest in the high-risk pool program. Fortunately I am able to obtain insurance otherwise).

There is one notable exception, Pennsylvania:

While other states have reported their high-risk plan applications are trickling in, Pennsylvania's response to PA Fair Care has been brisk. Applications are available online and about 3,000 individuals have applied so far. There is room for 3,500 in the first roll-out of the program.

What is going on?  It is unlikely that most of those 11.4 million working adults who do in fact qualify for the high-risk pools up and moved to Pennsylvania just in time for winter!

It turns out that Pennsylvania's high-risk pool program does something none of the other 49 state or federally run programs do:  The premium is not dependent on age.  It is fixed at $283/month for all, with a $1,000 deductible and a $5,000 out of pocket limit.

Compare and contrast:

In many states, people in their 40s and 50s face monthly premiums ranging from $400 to $600 and higher. "I think there's some sticker shock going on," said Sabrina Corlette, a Georgetown University research professor. "People who may be eligible are finding out that even if they can get the insurance, the price is too high." Pennsylvania, which set a premium of $283 for all ages, has had no problem getting applicants.

Associated Press

And that's just the premium.  In general, deductibles are higher (normally $2500) than in PA, and out of pocket can, by law, be as high as $5950.  Sure, Pennsylvania may end up having the opposite problem of the rest of the states: not enough money to cover all those who would like to participate.  If that happens, federal law gives them the option of raising prices or restricting enrollment.  But far better to help out as many people as can be helped, rather than not enough.

Along with the typical pricing schemes that go up with age, there are many restrictions written into the law that are partly responsible for the dirth of applicants.  Some of those are:

  • A barrier may include requirements that people be uninsured for at least six months and that people provide documentation that they've been turned down by an insurer. "There are many people who don't meet the criteria for the federal pool, particularly the six months without coverage," said Goldman. (Associated Press)

  • In states where the federal government runs the program directly, the insurance plan doesn't provide coverage for prescription drugs until people have met a $2,500 annual deductible. "Applying this high ... deductible to the pharmacy benefit is a real barrier to consumer access to medications," Steven Browning, a Texas official, wrote HHS last week. (Associated Press)

  • In Michigan, "So far, the biggest issue has been incomplete application forms. PHP is requesting a check for the first month's premium along with the application."

In fact, even a Republican Governor went so far as to request a waiver of the six-months coverage rule:

Saying federal regulations have created a "stone wall" preventing Connecticut residents from enrolling in a new state health insurance plan, Gov. M. Jodi Rell has asked U.S. Health and Human Services Secretary Kathleen Sebelius to consider relaxing the rule.

... Rell said enrollment could be limited because of the federal "crowd out" rule that requires a person be uninsured for at least six months before joining the plan....

"Implementation of such a restrictive, no-exception crowd-out/waiting period policy seems to contradict the stated goals of providing access to health insurance for those individuals with pre-existing conditions," Rell wrote to Sebelius.

Except that there is nothing Secretary Sebelius can do about it (AFAIK).  Congress enacted the law, and the law says that people must have been without insurance for six months before they become eligible.  That doesn't seem like there's much room for regulatory interpretation.

In a sane world Congress, noticing this problem, would consider amending the bill to allow for more coverage.  In a sane world, Congress might:

That's some of things Congress might do, if it weren't impossible for Congress to do anything other than pick it's collective nose while waiting around to fail to invoke cloture, that is.

There is one thing that Secretary Sebelius, in charge of the 23 Federal programs, and those state officials in charge of the various state-run programs, could decide to do regardless of Congressional inactivity: change the programs to use fixed-premium pricing regardless of age, as Pennsylvania is doing, thereby lowering premiums down to a semi-affordable level for those most likely to be applying.

I have no idea whether such a concept is being considered, but in light of Pennsylvania's success and many other states' failure to attract applicants, it's something that should be seriously considered.

Let there be no mistake: for those who are being helped, the high-risk pools are an awesome thing:

Preschool teacher Gail O'Brien, 52, was uninsured and facing cancer treatments that would have left her family deeply in debt. She now pays $495 monthly for a plan with a $5,000 annual deductible. She has a type of immune system cancer, and just one chemotherapy treatment runs to $16,000.

Lives are being saved, treatments are being covered, bankrupties and financial disasters are being averted.  But the program is capable of doing the same for a whole lot more people if there was a will out there to make it so.

Originally posted to jpmassar on Thu Oct 07, 2010 at 10:57 AM PDT.

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Comment Preferences

  •  Thanks for a factual (18+ / 0-)

    and informative diary. My opinion? The reason people are not signing up is indeed sticker shock. I'm sure lots of people don't have even the initial month's premium to send in with the application.  
        I'm following this issue closely as I contemplate how to handle my own situation. I must decide whether to go without insurance for six months so that I can apply to the Virginia high-risk pool, hoping that it will be still available and affordable by the time I could sign up, and that there will be a plan available for me.
        Asking a person under treatment for a life-threatening illness (in my case, breast cancer) to forgo insurance for six months is unkind. I must decide between continuing to pay exorbitant rates for less than optimum coverage, or going without any insurance for six months and hoping nothing too drastic happens during that time, and that there will be room at the inn at that time.
        I know if I give up my insurance now I'm not getting anything on the open market ever again, at least until 2014. And I don't feel secure in gambling that I'll be able to then, either.
        It's really tough being self-employed, single, and sick.

    To keep our faces turned toward change, and behave as free spirits in the presence of fate, that is strength undefeatable--Helen Keller

    by kareylou on Thu Oct 07, 2010 at 11:09:51 AM PDT

    •  I truly wish there was something (7+ / 0-)

      better this benighted country had to offer you.  And yeah, at this point, I wouldn't be willing to risk my life on the proposition that the PPACA would remain intact through 2014.

    •  Understatement of the day (7+ / 0-)

      Asking a person under treatment for a life-threatening illness (in my case, breast cancer) to forgo insurance for six months is unkind.

    •  How much would it cost (2+ / 0-)
      Recommended by:
      ladybug53, kareylou

      for six months worth of treatments?

      •  Depends, of course. (4+ / 0-)

        I'm out of the intensive phase of treatment now, maybe for good. I just stopped chemo in August (yeah me--I had six months of the high-dose IV stuff and then took 1825 (yes, I counted) pills, the last one on Aug 25).

        So maybe a couple hundred dollars a month if the big C stays away. If it doesn't--I went through at least $150,000 of treatment in a six month  period back in 2005.  

        Another point to consider is that I am now getting the lower negotiated rates for the insured. I had a scan recently that cost me $1500--I had to pay it because of my very high deductible, but I noticed that it had been negotiated down from nearly $4000. So if I go without insurance everything will cost more, and Georgetown U, in whom I have great faith, will no longer treat me.

        It makes my head spin just to try to consider all the factors and decide what to do.  

        To keep our faces turned toward change, and behave as free spirits in the presence of fate, that is strength undefeatable--Helen Keller

        by kareylou on Thu Oct 07, 2010 at 11:48:09 AM PDT

        [ Parent ]

    •  The price for these plans is very high. (10+ / 0-)

      And remember, the individual/family is paying the full cost of insurance-there is no employer contributing anything.  My family is on the Maryland Health Insurance Plan (MD has had a high-risk pool for several years) and we are using the High Deductible Option.  They base the premium on the oldest member of the family, which puts us in the $650/month category.  The shock is that there is a $2,600 deductible for each family member or a total of $5,200 per family deductible before insurance kicks in and pays 80%.  I just wrote a check for over $2,000 to my pharmacy yesterday for my husband's and daughter's medications - I'm hoping my husband has at least hit his deductible.  Oh, and another thing-none of these plans cover any dental.  I shelled out $1,000 for my son's wisdom teeth in August. He's got a cleaning appointment today and I just hope there are no cavities.

      A society grows great when old men plant trees in whose shade they know they shall never sit. -Greek proverb

      by marleycat on Thu Oct 07, 2010 at 11:22:31 AM PDT

      [ Parent ]

    •  Women's Cancer Screening & Treatment Program (3+ / 0-)
      Recommended by:
      gooderservice, jpmassar, kareylou

      I don't know where you are, but here, this program (run out of CDC, with separate funding, thanks to Bill Clinton or so I've heard after his mom died of breast cancer) is a lifesaver. If you need screening or treatment, you get it -- with much higher income limits than regular Medicaid, and no asset test. It probably varies from state to state, but for gosh sakes, ask your nearest social worker, or poke around on your state's website. I think it's lumped in with other "categorical eligibility" for Medicaid, like people on kidney dialysis.

      •  Thanks, I'm on it. (2+ / 0-)
        Recommended by:
        gooderservice, jpmassar

        I have a list of resources that may be able to help me and I am working my way down the list. This is going on the top of the list.

        To keep our faces turned toward change, and behave as free spirits in the presence of fate, that is strength undefeatable--Helen Keller

        by kareylou on Thu Oct 07, 2010 at 04:45:28 PM PDT

        [ Parent ]

    •  Not unkind, it's obscene. (3+ / 0-)
      Recommended by:
      gooderservice, jpmassar, kareylou

      Asking a person under treatment for a life-threatening illness (in my case, breast cancer) to forgo insurance for six months is unkind.

      The many obscenities in the way we do health care coverage in this country are enough to make anyone with a soul and a conscience absolutely heartsick.

      "Don't let what you cannot do interfere with what you can do." John Wooden

      by CKendall on Thu Oct 07, 2010 at 11:18:31 PM PDT

      [ Parent ]

  •  One more year till I get medicare... (6+ / 0-)

    Utah's high risk pool, assuming I qualify, would cost over $800/month for under-impressive coverage.  To qualify, I would have to have been refused coverage by insurance companies.  I'm convinced that the bastards would be willing to cover me - at twice that rate, which I can't afford anyway.

    Catch 22.

    Power isn't something you are given. Power is something you TAKE.

    by lonelyutahdem15 on Thu Oct 07, 2010 at 11:16:31 AM PDT

  •  Ease of access, another issue (13+ / 0-)

    When I called to inquire about the program, after two hours of searching for who to even ask, I got some snarky 'customer service' type person in Tallahassee (I swear it was a tea bagger you could just hear the contempt dripping from his voice that I was even asking about the high risk insurance pool) who told me it wasn't the state's problem, it was a federal one, and to go to the website for it. The State of Florida has a high risk pool, but it hasn't accepted new applications since the early 90's. Finding the right site with the information took more time, and then there was wading through the information available, the various plans and what they offered, and lastly discovering that without a 'turn down' letter you wouldn't be approved, at least not in Florida. The problem comes then in getting the turn down letter, when you're on a set income and you know, and they know you wouldn't be able to pay for the insurance policy in the first place, even with exclusions for pre-existing conditions, and so, they don't want to give you the letter.

    Luckily, I was finally approved for medicaid, though don't know how, I've been turned down for the past three years every time I've applied.

    Some states, I would suspect that especially those run by republithugs and tea party people, are making it as difficult as possible to even get to the information to find out about applying. There have been no advertisements here with information that I've seen about it. Those who are not politically active may know they exist but not have a clue how to access it. Some may not even know it's an option. And depending on the pre-existing condition, they may not have the energy or the resources to search. It would help if a few of the democratic candidates or representatives would put out commercials with the information. Use it to campaign, use it to inform about the benefits of the health care bill, but inform the people of what their options are and how to access those options.

  •  Although you haven't gotten a lot of comments (7+ / 0-)

    I think you've uncovered the problems with the system. They've given the reasons that came to my mind.  Ordinarily, that is something that would just be worked out by a reasonable legislative body.

    I saw some comments by Canadians saying it took 20 years for their health system to evolve and that it started in one province.  I don't know how long Medicare was tinkered with.

    So, the problems are showing up.  We need to work hard to get Democrats in office and work on improving it and I'll never stop until my ashes are scattered.  And even then I'm contemplating coming back to haunt Boehner and Lieberman. [yes, snark...I think :) ]

    I can't change the direction of the wind, but I can adjust my sails to always reach my destination. ~Jimmy Dean

    by ParkRanger on Thu Oct 07, 2010 at 11:35:21 AM PDT

    •  yep (4+ / 0-)
      Recommended by:
      jpmassar, CKendall, SoCalSal, ParkRanger

      We need to work hard to get Democrats in office and work on improving it and I'll never stop until my ashes are scattered.  

      Thank you. You are a good person.

      To keep our faces turned toward change, and behave as free spirits in the presence of fate, that is strength undefeatable--Helen Keller

      by kareylou on Thu Oct 07, 2010 at 11:37:58 AM PDT

      [ Parent ]

      •  Well, thank you. I must admit I had a lot of fun (2+ / 0-)
        Recommended by:
        jpmassar, kareylou

        thinking of haunting Boehner and Lieberman.

        It's really not over until it's over and even then it's just a new beginning.  They don't have control and that's why they are so eager to disempower people. We have so much more power than we realize.

        A lot of good is happening with the health care plan right now. People are being helped. Good.  So we work to get more.

        I can't change the direction of the wind, but I can adjust my sails to always reach my destination. ~Jimmy Dean

        by ParkRanger on Thu Oct 07, 2010 at 11:49:00 AM PDT

        [ Parent ]

  •  I thought I was eligible for the program in my (9+ / 0-)

    state but I did not meet the 6 mos. w/o insurance. Luckily they had a HIPPA program wherein my company (because it closed) terminated their group policy thus making COBRA impossible. The state then covers the COBRA. But the insurance (while with the same carrier that I had under the group coverage, and whom denied me an individual policy due to high-risk ~ hbp), is crap! 80/20, $5000 deductible, for $350 a month. That was the cheapest I could get. Did I say I didn't have a job?

    Earth: Mostly harmless ~ The Hitchhiker's Guide to the Galaxy (revised entry)

    by yawnimawke on Thu Oct 07, 2010 at 11:52:48 AM PDT

  •  I'm still here (8+ / 0-)

    Still unemployed, still uninsured, with three months' worth of antipsychotics from a compassionate psychiatrist who gave me that many samples of stuff I desperately needed. I don't have $2500 lying around gathering dust to shell out for overpriced pills not available in generic. Because I own a vehicle worth more than $2000 I don't qualify for Medicaid. Because I don't have a disability rating and I didn't see combat I don't qualify for veteran's health care. Because I don't have children I don't qualify for any state-provided family care plans. And because I have schizophrenia and Polycystic Ovary Syndrome I will be turned down by the free market for coverage, or forced to pay a premium I can't afford.

    Did I mention I'm unemployed?

    When are you going to understand that being normal is not necessarily a virtue? It rather denotes a lack of courage. - Practical Magic

    by Keori on Thu Oct 07, 2010 at 12:17:46 PM PDT

  •  Great diary, important subject (3+ / 0-)
    Recommended by:
    ladybug53, Betty Pinson, kareylou

    I am older, disabled and covered by Medicare. I spend a lot of time keeping up with the new HCR law, but know next to nothing about this.

    First, are those with "high risk" probs more likely to be covered?

    Second, the Right (and the Insurance Cos) have done a great snow job on the deficiencies of the Act.

    Third, the addition of another layer of "enrollment" is anathema to Americans.

    Fourth, where are the letters in the mail? I get plenty offering to make me a stud, get rich with gold bars, improve my eye sight, etc.

    One would be excused for thinking that somebody doesn't want the exchanges to work!


    Some people make you want to change species

    by ulookarmless on Thu Oct 07, 2010 at 12:18:16 PM PDT

    •  Duh *pools* not exchanges, the brain, the brain (0+ / 0-)

      Some people make you want to change species

      by ulookarmless on Thu Oct 07, 2010 at 12:19:56 PM PDT

      [ Parent ]

    •  The high-risk pools were set up to (3+ / 0-)
      Recommended by:
      ulookarmless, Betty Pinson, SoCalSal

      provide insurance for people with pre-existing conditions that insurers won't cover.

      The term 'high risk' is not exactly correct, but that's just what the program has come to be known as.

      Not sure what you mean by 'another layer of enrollment'.  You enroll in the high-risk pool the same way you enroll in any other insurance plan: fill out the appropriate forms and send them a check.

      It would be nice to get a letter in the mail if you are eligible for this program, but I'd guess it would very difficult for the government to determine if you were a good candidate for eligibility or not.

      •  I meant any announcement to the general (1+ / 0-)
        Recommended by:

        public that these programs are available and who is eligible and what you have to do to enroll.

        Seems to me this is a well kept secret unless you go looking and know where to look.

        Even the obfuscation of the term "high-risk" kinda makes my point.

        What chance does a 35yo single working mother of a child who qualifies for the pool have under these rules? She probably doesn't even know the program exists.


        Some people make you want to change species

        by ulookarmless on Thu Oct 07, 2010 at 05:00:02 PM PDT

        [ Parent ]

        •  There were certainly newspaper articles. (0+ / 0-)

          And the President noted them when they started.

          How does the government go about making "an announcement to the general public" if not through the press?  I guess they could send US mail to every single person.  Maybe they should have.

          •  They do it for Medicare (1+ / 0-)
            Recommended by:

            and many other federal programs, through your pay check deductions, IRS advices etc.

            I have been both employer and employee. If the feds want to advise you, they can do so pretty quickly.


            Some people make you want to change species

            by ulookarmless on Thu Oct 07, 2010 at 08:33:19 PM PDT

            [ Parent ]

  •  Me? I'm lazy and haven't done Indiana's yet. (0+ / 0-)

    "Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity." --M. L. King "You can't fix stupid" --Ron White

    by zenbassoon on Thu Oct 07, 2010 at 02:05:27 PM PDT

  •  Its sad (0+ / 0-)

    But the truth is that of the X million who are un-insured are so because they are not planning ahead "period" . To get this % I am talking about to take any kind of preventive care is going to a struggle . Even if we had 100% nationalized health care they would still require outreach programs to get them to act responsibly instead of waiting till the last minute.  

    •  I acted responsibly (1+ / 0-)
      Recommended by:

      I never smoked, rarely drink, have never done drugs ate healthy foods and exercised every day, but I still got cancer at age 34.  

      I hate when people assume the "sickies" did this to themselves and are getting what they deserve.

      Everyone I've met since my diagnosis was completely sidelined by their diagnosis and, at the time, had always had health insurance and never ignored symptoms or let things go.  Just because the MSM uses stock footage of the backsides of heavy people jiggling down the street when talking about health related stories doesn't mean we all got sick because we ate cheeseburgers morning, noon and night.  

      Sorry for the rant, but I spent last summer getting yelled at by teabaggers that my situation was all my own fault.  

      I had cancer, I can't get insurance, if my cancer comes back? The Plan: Walk It Off!

      by ArtemisBSG on Fri Oct 08, 2010 at 01:22:22 AM PDT

      [ Parent ]

  •  I haven't even tried Indiana's. (3+ / 0-)

    The last time I checked, they will cover my husband (not me) for $350 a month.

    We make about $1250 a month.

    So it's not that we don't have it offered, just that we can choose between having the heat on and eating or insurance.

    •  Come 2014 you will decide (2+ / 0-)
      Recommended by:
      Alexandra Lynch, jpmassar

      between the cost of the premium and the tax penalty for not having insurance and I predict you will choose the tax penalty.  You will still not have insurance.  

      Or you will pay the premium instead of the tax penalty but you will still not have effective insurance because you cannot pay any deductibles or co-pay, meaning the insurance company gets your money and you get nothing in return.

      Almost all the people who will have to pay the penalty will be the poor, the working poor and those without enough education to understand the system.  A beautiful system pushed through by progressives.  

      Don't even try to tell me about baby steps.  I sincerely hope a court somewhere (anywhere) strikes down the mandate before it takes effect.  Any bill with a mandate but not a public option is worse than the system we had a year ago and should have had a stake driven through its heart.  A silver stake soaked in cyanide.

      I think, therefore I am. I feel, therefore I am a Democrat.

      by Endangered Alaskan Dem on Thu Oct 07, 2010 at 10:34:18 PM PDT

      [ Parent ]

  •  I got my application and I am frustrated (2+ / 0-)
    Recommended by:
    Wayward Son, jpmassar

    I got my application in early September, I filled it out and got the things ready that I could, doc info, condition, birth certificate etc.    

    But, I haven't had insurance since being dropped in 2006(I am absolutely, positively, without a doubt an automatic denial) yet for some reason the companies I've called so far to get that precious rejection/denial letter are refusing to give this little automatic denial lady anything until I fill out the application and submit the first months premium and then they "might" deny me or they  could take me this time (Mr. Underwriter hinted I might get approved!) but they will just automatcally charge me whatever premium they see fit - that's what Mr. Aetna underwriter told me.

    I asked him:

    ME: So if you approve me, instead of the $283 from the website, if they take me they'll just charge me a much higher premium and just put it on my bank/charge card that I submit?

    INS. DUDE: Oh yes, since the health reform passed you might be able to get coverage with us after all.

    ME: But I don't want you I can't afford you, you'll charge me probably $800 or $900 a month right?

    INS. DUDE: Well, yes, you would have submitted an application.  

    ME: But I just need a denial letter to submit with my application.  Can't you just send me a rejectionletter? I'm supposed to be an automatic denial.

    INS. DUDE: No you have to follow the procedure.

    This was the worst of the conversations with insurance companies.  

    Guess what?  I only have enough money for the $339 premium for the PCIP and that's it.  I don't have a premium to have floating around out there waiting for them to decide if they want me and then send my money back in probably 6-8 weeks.  I just cannot do that, I am paycheck to paycheck and $339 a month with a $2500 deductible for CA is going to be hard enough to manage.  

    This is where I'm at and I am frustrated.  

    The PCIP people even called me last week to follow up on why I haven't sent the application in yet, and I told them about not being able to get a damned letter and they were nice but had absolutely no solution for me.  

    Anyone know what I can do besides to fabricate a letter on my own?  Which I am reluctant to do because I was not raised that way.

    I had cancer, I can't get insurance, if my cancer comes back? The Plan: Walk It Off!

    by ArtemisBSG on Fri Oct 08, 2010 at 01:16:28 AM PDT

  •  A new business idea.. (1+ / 0-)
    Recommended by:

    Start an insurance company that doesn't write policies.

    For a small application fee, it denies everyone and provides them a letter they can use to apply for a high risk pool.

    "To pass these defendants a poisoned chalice is to put it to our own lips as well." Justice Robert Jackson, Chief Prosecutor, Nuremberg.

    by Wayward Son on Fri Oct 08, 2010 at 05:33:30 AM PDT

  •  High Risk Pool is a terrible idea to begin with (0+ / 0-)
    Whoever came up with this idea needs to be kicked in the head. The whole point of having an insurance pool is so you can spread the risk among the whole population, both healthy and sick. Now if you set up a pool that only includes sick people- how in feck's name is that supposed to work? Of course it's not going to work. his is just a plain lousy idea. It was probably a giveaway for the insurance companies. They just LOOOOOVE it when the government takes care of the sick people (just like they love Medicare) and leave them with the healthy people.

    In short- high risk pool= bad idea. Let's just try to forget all about it until 2014, when the actual exchanges are up and running, and we dn't have to use these half-assed idiotic 'solutions' anymore.

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