Fed­eral in­surance pool open to high-risk Tex­ans

Austin American-Statesman - - METRO&STATE - By Tim ea­ton AMER­I­CAN-STATES­MAN STAFF

Many unin­sured Tex­ans with med­i­cal con­di­tions will be able to sign up for health in­surance be­gin­ning to­day un­der a new fed­eral pro­gram.

The so-called high-risk pools are in­tended to pro­vide in­surance to the pre­vi­ously unin­sur­able. The pools, which will cost $5 bil­lion na­tion­ally, were in­tro­duced as part of the sweep­ing health care law passed by Congress in March.

Cov­er­age will be­gin Aug. 1 if peo­ple ap­ply by July 15, of­fi­cials said.

“Peo­ple with pre-ex­ist­ing con­di­tions will be treated like ev­ery­one else,” said Jay An­goff, the di­rec­tor of the fed­eral Of­fice of Con­sumer In­for­ma­tion and In­surance Over­sight, which is over­see­ing the pro­gram.

States had the op­tion of run­ning the pro­grams or al-

low­ing the U.S. Depart­ment of Health and Hu­man Ser­vices to run them.

Texas — along with 21 other states — opted out, and the fed­eral govern­ment will ad­min­is­ter the pro­gram, now known as the Pre-Ex­ist­ing Con­di­tions In­surance Plan. The po­ten­tial al­lo­ca­tion for Texas, if it had cho­sen to run the pool, was $493 mil­lion, ac­cord­ing to Health and Hu­man Ser­vices.

Gov. Rick Perry, who has op­posed the fed­eral in­surance re­form law, said in a state­ment Wed­nes­day that Texas of­fi­cials “hope that the fed­eral high risk pools are run ef­fec­tively and ef­fi­ciently.”

“We are still concerned about the lack of re­li­able fed­eral fund­ing and what it means for Tex­ans once the fed­eral fund­ing has run out. The State of Texas has been ad­dress­ing the needs of these high risk in­di­vid­u­als with our own pool for 12 years, and will con­tinue to do so.”

Texas’ high-risk pool costs con­sumers twice as much as the fed­eral one. Peo­ple en­rolled in the fed­eral pool will pay a pre­mium equal to stan- dard mar­ket rates.

En­rollees in the state plan can­not sim­ply switch to the fed­eral plan be­cause to be el­i­gi­ble, a per­son must have been with­out in­surance for the pre- vi­ous six months.

Health and Hu­man Ser­vices has ac­cess to some in­for­ma­tion to ver­ify el­i­gi­bil­ity, but Richard Pop­per, di­rec­tor of the fed­eral in­surance pro­grams, said the depart­ment would rely largely on the hon­esty of the ap­pli­cants.

Deeia Beck, head of Texas’ Of­fice of Pub­lic In­surance Coun­sel, which aims to as­sist con­sumers, said the fed­eral govern­ment should have al­lowed peo­ple to drop the state cov­er­age and get into the fed­eral plan.

“It’s un­for­tu­nate that the feds didn’t ad­dress that prop­erly,” Beck said.

The fed­eral pool is in­tended to be a stop­gap. Start­ing in 2014, in­sur­ers will be pro­hib­ited from dis­crim­i­nat­ing against ap­pli­cants based on pre-ex­ist­ing con­di­tions, and peo­ple will have ac­cess to pri­vate health in­surance choices through ex­changes, which will be mar­ket­places for health plans.

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