Posts Tagged ‘high-risk pools’

Ben Cutler: An Insurance Industry CEO Responds to Healthcare Reform

Tuesday, April 26th, 2011

Is the healthcare insurance industry the scapegoat for rising premiums?  In the inaugural episode of the Chuck Lauer Show,  presented by Alter+Care, the former publisher of Modern Healthcare Magazine talked about the insurance industry’s take on healthcare reform with Ben Cutler, Chairman and CEO of USHEALTH Group, Inc., who previously led Fortis Healthcare.  Cutler currently serves on AHIP’s Executive Committee, serves on AHIP’s Board and is also the Chairman of AHIP’s Membership Committee.  The Chuck Lauer Show is an ongoing conversation about the future of healthcare with the leaders and thinkers who are shaping a new direction for healthcare in the United States. 

Cutler, who has spent more than 30 years in the healthcare insurance industry, recalled the ongoing national debate that began nearly 20 years over HillaryCare with the objective of how to provide universal coverage for the more than 50 million uninsured Americans.  Cutler believes that the Obama administration has chosen to focus on access and doesn’t sufficiently address affordability issues.  Healthcare industry groups recognized that the day would come when reform would be a top-line issue and that we would not be well served by just saying “no”.  Cutler says “We’ve worked hard on positioning the industry to accommodate reforms and tried to be very accommodating because getting more people covered is a laudable objective.”

As the healthcare reform bill was drafted, it soon became clear that the insurance industry would have a problem with some of the issues.  Unfortunately, according to Cutler, the politicians decided they needed an enemy and “that turned out to be us.  We continue to be vilified as an industry”, a situation that could – and should — have been avoided.  The Patient Protection and Affordable Care Act will have some unintended consequences in terms of how the legislation will affect the behavior of various stakeholders who comprise the healthcare economy – consumers, providers, insurers, regulators, etc.  It is inevitable that the insurance industry will have to raise rates if they are to comply with the healthcare law, which essentially constitutes a new tax on the American people.

Cutler cites the example of the $5 billion set aside to subsidize people in high-risk pools.  The government estimated that by this time, upwards of 500,000 individuals would be enrolled in these pools.  So far, just 8,000 people have signed up, an example of where government expectations were totally unrealistic.  Additionally, there is the issue of pre-existing conditions, which the government has characterized as an industry-abusive position, and one which relates to affordability of coverage.  According to Cutler, if people buy homeowners’ insurance only after their house catches fire, the premium obviously would be higher.

 
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Illinois Introduces Pre-Existing Insurance Plan

Monday, August 30th, 2010

Illinois Pre-Existing Condition Insurance Plan is expected to cover 4,000 to 6,000 individuals.  The state of Illinois has created the Illinois Pre-Existing Condition Insurance Plan (IPXP) for individuals with pre-existing conditions who lack medical insurance.  Enrollment will be on a first-come, first-served basis and is funded by premiums and the federal government, which is giving the state $196 million to operate the program until 2014.  The funding is expected to cover between 4,000 and 6,000 people – nowhere near the 1.7 million Illinoisans who currently lack healthcare insurance.

“This program is not a silver bullet that will solve all health insurance problems in Illinois,” said Michael McRaith, director of the Illinois Department of Insurance.  Illinois is one of approximately 30 states establishing similar “high-risk pools” under the healthcare reform legislation passed in the spring.  Congress has set aside $5 billion to fund the pools, although this is not enough money to cover existing needs.  As many as 400,000 people nationally are expected to enroll in their state programs.

To qualify for IPXP, a person must be uninsured for six months, have a pre-existing condition, be a United States citizen or a legal resident, and be unable to get insurance from another source.  There is a $2,000 deductible and dependents are not covered.  Premiums will vary, but a Chicagoan who is 25 and doesn’t smoke will pay $149 a month.  The older the patient, the higher will be the premium.

High-Risk Pool Healthcare Has Hefty Premiums

Monday, July 19th, 2010

“High-risk pool” healthcare coverage comes at a steep price.  Healthcare coverage for uninsured Americans with pre-existing conditions won’t come cheaply. Premiums in the new “high-risk” pool could average $300 to $600 a month in certain states, according to a new government website.   The Department of Health and Human Services says that the premiums could range from $140 to as much as $900 a month.

According to Richard Popper, deputy director of the Office of Consumer Information and Insurance Oversight, “There are going to be meaningful premiums that are going to be required to stay in this plan…in the hundreds of dollars.”  HealthCare.gov estimates show that monthly premiums for a 50-year-old Floridian would be $552 to $675; for a New Yorker, the average cost would be $400 to $600; $491 to $600 for a Texan; and only $283 for a Pennsylvanian.  Coverage under the Pre-Existing Condition Insurance Plan begins on August 1.

Consumer advocates are advising the uninsured who have health problems to sign up quickly – despite the cost – because they cannot be turned down for coverage.  The high-risk pool is a temporary solution for at-risk individuals who cannot get healthcare insurance because of a medical condition.  The pool will be available until 2014 when healthcare reform takes full effect.  At that point, insurance companies will not be allowed to turn down people in poor health.  Low- and middle-income individuals will receive subsidized coverage.

Temporary High-Risk Pool Short on Funding

Wednesday, July 7th, 2010

healthcare20reformAlthough between 5.8 and seven million Americans may qualify for healthcare coverage through the temporary high-risk pool program created as part of healthcare reform, the $5 billion set aside for use between now and 2014 may cover only 200,000 patients annually.

The high-risk pool, created by the 2010 Patient Protection and Affordable Care Act, provides subsidized coverage to uninsured individuals with pre-existing medical conditions.  One portion of the law provides income-based subsidies so healthcare coverage is more affordable and accessible.  Because most of the provisions do not become effective until January of 2014, however, the limited funding means available dollars will have to be stretched as far as possible, said Paul B. Ginsburg, Ph.D., NICHR director of research.  The National Institute for Health Care Reform (NIHCR) has identified key policy considerations in its Health Coverage for the High-Risk Uninsured:  Policy Options for Design of the Temporary High-Risk Pool policy analysis.

According to Kaiser Health News, many people with medical conditions may be unable to obtain coverage.  “That fear — along with partisan considerations — prompted officials in 20 states to decline to establish their own federally financed pools, opting to leave the task to Washington.  Officials in those states, predominantly Republicans, worry that they would face intense pressure to pick up the burden if the money runs out.”