Pa. leads in high-risk insurance enrollment
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Pennsylvania's new "high-risk" insurance plan, meant to provide coverage for uninsured people with pre-existing health conditions, still has room for new enrollees but is dramatically outperforming similar state plans across the country.
So far, more than 1,650 people are enrolled and receiving benefits through the federally subsidized PA Fair Care program, which costs $283 a month. To be eligible, an applicant must be without health insurance for at least six months and must be unable to obtain coverage because of medical conditions.
Pennsylvania's $283 monthly rate, plus co-pays and deductibles, measures favorably against other states, where monthly premiums can reach $972 a month. The take-home message, three months into the program, seems to be that the more affordable the policy is, the more people will buy it.
The state Insurance Department says it has room for up to 3,500 enrollees, meaning that, as of the end of October, Pennsylvania's high-risk program was operating at roughly 50 percent of capacity.
But most states are running at 10 percent capacity or lower, according to statistics provided last week by the U.S. Department of Health and Human Services. In fact, nationwide, only 8,011 have enrolled in the high-risk pools as of Nov. 1.
That means Pennsylvania accounts for more than 20 percent of the nationwide total. It is providing coverage to more people than any other state.
On top of the 1,650 with coverage under the program, an additional 2,300 had applied through the end of October. So far, 1,700 of those are still "pending," meaning they may or may not be eligible.
Six-hundred have already been denied coverage, either because they had no pre-existing condition, they'd had coverage within the six-month window or because they were dropped from the program for other reasons (they couldn't afford the premiums, they found a job and that provided insurance, they were approved for Medicaid coverage, etc.).
"I think there are three reasons that Pennsylvania is doing so well," said Insurance Department spokeswoman Melissa Fox. "First, our premium is more affordable than other states' [because] it is community rated -- spreading the risk among a large group -- and not rated by age or condition."
Second, she said, Pennsylvania's list of eligible pre-existing conditions is more comprehensive than other states', and third, Pennsylvania's application is online only, which speeds the enrollment process.
Pennsylvania, which began taking applications Aug. 5 and offering coverage in September, also publicized the program via radio and Internet ads.
By comparison, New York (which began offering coverage Oct. 1) and Florida (Aug. 1) have enrolled fewer than 300 people each. California, the most populous state in the country, has enrolled 513. Many states have fewer than 50 people enrolled, according to health department data.
Overall, it's a disappointing showing for the program, known federally as the Pre-Existing Condition Insurance Plan.
As part of the health care overhaul passed by Congress and signed by President Barack Obama earlier this year, the federal government is making $5 billion available to cover high-risk customers across the country. The "bridge" coverage is scheduled to be in place until 2014, when new rules take effect forbidding insurers from denying or terminating coverage based on a pre-existing health issue.
While the enrollment is below expectations for President Obama's goals, the results are disappointing for Republicans, too, who have historically pointed to high-risk pools as one way to bring more uninsured people into the insurance marketplace.
The GOP's "Pledge to America," drafted in the run-up to the November elections, said, "We will expand state high-risk pools, reinsurance programs and reduce the cost of coverage." In 2008, Arizona Sen. John McCain, then the Republican presidential candidate, said an expansion of subsidized high-risk "guaranteed access plans" would have been one of the major components of his plan to remake the health care system.
Pennsylvania is receiving $160 million to run its version of the high-risk plan. Twenty-three states declined the money, deferring to the federal government and letting the feds operate the program.
Visit www.pafaircare.com for more details or to apply for coverage. The plan is administered by Pittsburgh's Highmark Inc.
First Published November 9, 2010 12:00 am