Advocates for uninsured say high-risk pool will test change

May 4, 2010 at 12:00a.m.

Associated Press

COLUMBUS

The state’s new high-risk insurance pool for people with pre-existing health conditions will be the first test of whether Ohio can deliver on the promise of President Barack Obama’s vision for change, advocates for the uninsured said Monday.

Ohio was one of 27 states to notify the administration last week of its interest in running special high-risk insurance pools for people with diabetes, cancer or other health problems. The programs will be in place until 2014 — when health insurance companies will no longer be allowed to deny coverage to people in poor health.

The federal government will step in and run risk pools in states that don’t set up their own.

Obama’s health care overhaul sets aside $5 billion for the program, with Ohio getting about $152 million to help subsidize, or pay for, part of a monthly insurance premium. But it’s unclear how affordable the insurance pool will be or how many Ohioans initially will be covered when it begins July 1.

That depends on the way benefits are packaged and priced, said Cathy Levine, executive director of the Universal Health Care Action Network of Ohio. A 2005 feasibility study estimated that as many 17,250 Ohioans could be enrolled in a government high-risk pool with a premium set at $476 per month.

Ohio, like other states, is waiting on federal guidelines to implement the program. That could come by the end of May, said Carly Glick, spokeswoman for the state Insurance Department.

“Whatever the program ends up looking like, it has to be enough to provide adequate coverage that protects people from financial ruin,” Levine said.

Under the law, high-risk pools will be open to people who have been uninsured for at least six months, at a cost similar to what others pay. Employer-provided health insurance averages nearly $5,800 a year for an individual.

The Department of Health and Human Services will determine the minimum benefits, and the plans must limit out-of-pocket spending to $5,950 for individuals and $11,900 for families, excluding premiums.

About 375,000 people nationwide could be covered by the high-risk pools in 2010, according to a December report by the Centers for Medicare and Medicaid Services. But the report also said the program could go through $4 billion in its first year, and run out of money as early as 2011.

A message was left Monday at the Department of Health and Human Services. The agency has previously stated it believes it has the resources to provide coverage.

Levine said advocates for the uninsured will press Congress for additional money if the funding runs out.

Overall, about 1.3 million people lack health insurance in Ohio.