ShareThisSACRAMENTO, Calif. - Californians whose medical problems make it almost impossible to buy private health insurance could pay dramatically lower premiums starting in the fall for new, federally subsidized insurance.
California administrators this week made some preliminary decisions about costs and deductibles for a new high-risk insurance pool, which will be one of the earliest parts of federal health care overhaul to go into effect.
The state tentatively plans to run that federal program alongside its own existing high-risk pool, but each will have different rules and different prices.
For the first time this week the state board that will run both programs got a look at how widely those prices could vary.
A 50-year-old San Francisco woman who pays $915 every month for the state's high-risk coverage could pay $575 a month for the federal policy, consultant Pete Davidson told the Managed Risk Medical Insurance Board.
That 37 percent price difference "makes the reform real. It brings it down to dollars and cents," Anthony Wright, head of Health Access California, said.
In the most detailed look yet at how this part of the health care revamp could take shape in California, Davidson also told the board that federal subsidy money would help insure between 16,000 and 44,000 Californians.
The final number will depend partly on how sick those people are and how much it costs to care for them.
The board also decided on a $1,500 annual deductible for the federal program.
Californians should be able to start signing up for the new coverage on Sept. 1, Cliff Allenby, chair of the Managed Risk Medical Insurance Board, said in an interview.
Under current law, individuals who have common medical conditions, from asthma to backaches, can legally be rejected by health insurance companies in California. Federal health care overhaul forbids such rejections nationwide, but not until 2014.
As a stopgap until then, the federal government has set aside $5 billion for special high-risk insurance pools that were supposed to start up this summer and run through the end of 2013. The law gave states the option of running their own pools or letting the federal government run a pool for their residents. California could get $761 million to run a federal pool here.
No one expects that money to last.
"All the states are saying, 'Our portion of that is just a drop in the bucket. It's nowhere near enough to deal with all the uninsured people', " said Elizabeth Abbott, a consumer representative who advises the National Association of Insurance Commissioners.
An analysis by the National Institute for Health Care Reform estimated the $5 billion could cover about 200,000 people for 31/2 years. That's in a nation with roughly 50 million uninsured, close to half of them with some sort of chronic condition.
The state's long-standing high-risk pool, which is partly funded by a tobacco surtax, caps enrollment at 7,100 and often has waiting lists. The new pool, too, could have waiting lists.
"It will be like a mad lottery," said Betsy Imholz, who specializes in health reform issues for Consumers Union in San Francisco.
For people who can't get standard health insurance, the federal high-risk pool could pose difficult choices.
It appears likely to be cheaper than the state's pool, but it is open only to people who have had no insurance for six months - and no one knows when or if a waiting list could start forming.
Consumer advocates generally advise everyone to have health insurance, because without coverage, anyone is just one car crash, one bad fall or one scary diagnosis away from bankruptcy.
(E-mail reporter Carrie Peyton Dahlberg at cpeytondahlberg(at)sacbee.com.)
(Distributed by Scripps Howard News Service, www.scrippsnews.com.)
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