High-risk insurance pool gets redirected

By Lora Hines,



　

Gov. Rick Perry, who has railed against federal health care reform, is pushing thousands of Texans in the state's high-risk insurance pool into the marketplace set up by the Affordable Care Act.

An estimated 23,000 members of the Texas Health Insurance Pool were notified last month that their coverage would end Dec. 31, and that they would need to enroll in new coverage through the federal marketplace at healthcare.gov or buy it from an insurance company, the insurance pool's executive director, Steven Browning said in an email.

New coverage must be bought by Dec. 15 to ensure continuous coverage on Jan. 1, 2014. Pool coverage will not extend beyond Jan. 1, no matter whether a member is hospitalized at year's end, Browning said.

Texas is among 35 states that operate high-risk insurance pools for residents with pre-existing health conditions, including cancers, heart disease and diabetes, and who can't find coverage elsewhere. Many of the programs will close next year and require members to buy coverage in the insurance marketplaces, according to the National Association of State Comprehensive Health Insurance Plans.

Perry signed a bill this summer calling for the end of the Texas insurance pool, which began in 1998. The pool primarily is funded by policyholders' premiums and insurance industry assessments. It also receives some federal grant money, but no state money.

Josh Havens, a Perry spokesman, said maintaining the state insurance pool only would have duplicated federal efforts and would not be a best use of state resources.

Perry has been a strong opponent of the president's health care law, saying in August: "Texans are already subject to too much costly and burdensome federal regulation, and Obamacare only makes the problem worse."

Browning, patient advocates and patients said pool members should be able to find coverage as good or better than that offered in the pool. Those in the pool typically pay two times the market rate for insurance.

Stacey Pogue, senior policy analyst with the Center for Public Policy Priorities, said pool insurance is coverage of last resort for many people because of its high cost. She said it's no surprise that Texas and many other states are closing their high-risk insurance programs.

"It's a broken insurance market," Pogue said. "Nothing makes sense to have it in the future. Most states have looked at doing this."

After comparing marketplace and pool plans, she said her organization found that all pool members would benefit in the marketplace, which offers subsidies for those who qualify. However, Pogue said some members might be anxious about the closure because they've never had to shop for insurance.

"Some people have been in the pool since 1998 when it opened," she said, adding that she thinks Browning is trying to ease the transition.

The insurance pool website lists links to several organizations and agencies that have information about the marketplace, as well as subsidy calculators. It also includes the notification sent to all members, plus answers to frequently asked questions about marketplace plans.

Pogue recommended that risk pool members, many of whom require frequent medical care, begin researching marketplace plans well in advance of the Dec. 15 deadline to avoid coverage breaks.

Houston resident Margaret Kallsen said state health insurance pool officials twice notified her that the program would close Dec. 31.

She estimates her monthly $673 risk pool premium could almost be cut in half based on research she has done on marketplace premiums and subsidies.


lora.hines@chron.com
Source: Houston Chronicle