Slow start for state-run health care
Just 1,314 are enrolled in Pennsylvania program for high-risk patients.
Health care pools, run by states and the federal government to provide coverage at reduced rates for people whose illnesses have locked them out of private insurance, aren't proving as popular as policy-makers had hoped.
One reason? Underneath the gift-wrapping, the plans are too expensive for many to afford.
In Pennsylvania, just 1,342 have enrolled as of October in the state's PA Fair Care, which has the capacity to serve almost three times as many this year. And according to the state's insurance office, Pennsylvania's program is decidedly more popular than its counterparts around the country.
Across the Delaware River, New Jersey has only received 150 applications for 20,000 slots. Ohio had hoped to get 400 enrollees a month for its plan, but September only saw 225; October, just 158.
The U.S. Department of Health and Human Services wouldn't release numbers on the federal program, but those who monitor the insurance industry say it's hardly faring any better.
"We're kind of surprised at the low take-up so far," said John Greene, vice president of congressional affairs at the National Association of Health Underwriters.
Acknowledging that the plans are expensive and have requirements that some people can't meet, he said many people don't even know they're available because they haven't been widely advertised.
"Education is a real uphill battle. I think the numbers will go up over time, the longer it's out there and the more people get to know about it," Greene said.
Part of the historic health care reform legislation passed earlier this year, the high-risk pools bridge the gap until 2014, when a rule prohibiting insurance companies from discriminating against people with pre-existing health conditions takes effect. Given the option of developing an independent program to serve the need or signing onto the federal equivalent earlier this year, Pennsylvania and 27 other states chose to go their own way.
Funded by a $160 million federal grant, PA Fair Care offers coverage for $283 a month. [That's not bad compared to my Blue Cross plan at $386/mo, with no pre-existing conditions ... and Medicare at $329/mo.] While the cost is far below what private insurers would charge, it's more than many people can afford. The program has enough money to serve 3,500 people this year before jumping to 5,300 in 2011.
Judging by the current rate of applications, there will be plenty of open slots for some time.
"We didn't know what to expect," Insurance Department spokeswoman Melissa Fox said. "Let's face it: A success would be having one person covered."
To qualify in Pennsylvania, you must be a resident, have been uninsured for six months and have a pre-existing medical condition. Unlike Pennsylvania's plan, the federal plan requires documentation from a private insurer that an applicant was denied or offered incomplete coverage because of an illness.
That's a big stumbling block nationally.. Many patients don't have that documentation handy, necessitating another round of applications and denials by private insurers before they can sign on to the government plan. State officials also think many potential applicants don't meet the six-month requirement and are waiting before applying.
The next hold-up is price. Pennsylvania's charge of $283 a month regardless of age is competitive compared to New Jersey's rates, which go from as low as $212 a month for patients under 25 up to $768 for those over 65. The federal plan charges between $320 and $570 a month, depending on the state.
That's much cheaper than private plans for sick patients, which can hit $1,500 a month. But it's still far above typical rates — a healthy person can get individual coverage for about $75 a month, [Would have to be for a very young person for such a low premium. Or perhaps that figure is for very minimal coverage?] Greene said — and often out of reach for poorer families.
"That's been a complaint from the beginning," Greene said. "They say, 'Oh good, I can get in,' but when they look at what it costs, it's still not affordable."
As Doug Anderson, chief of policy at the Ohio Department of Insurance, said, it's been a long slog letting patients know the program even exists. He's largely relying on word of mouth and referrals from hospitals, a strategy mirrored in Pennsylvania and New Jersey.
"We initially relied on unpaid media to get the word out," he said. "We also did a radio campaign around the state. But we did not go paid TV or paid newspapers. What we were told from the people who do high-risk pools is that you need to do targeted outreach."
State officials all say the same thing: Give us time. The patients will come. Christmas isn't over yet.
"It just happened this summer," said Marshall McKnight, spokesman for the New Jersey Department of Banking and Insurance. "It's very early. The word is still getting out."