The Edmond Sun

Local News

August 29, 2012

State high-risk pool director speaks on insurance

ENID — As Oklahoma lawmakers watch and wait to see the outcome of November’s election before making any decisions on implementing “Obamacare,” one element of the plan already is fully operational in the state.

Tanya Case, executive director of Oklahoma Temporary High Risk Pool, was in Enid Monday to discuss the health insurance plan, which is designed to cover people with pre-existing medical conditions.

The temporary pool was established in Oklahoma in September 2010, in accordance with the Affordable Care Act. States that did not establish their own temporary pool had one established for them by the federal government.

If the Affordable Care Act remains intact, commercial insurance carriers will not be permitted to exclude people from coverage due to pre-existing medical coverage.

“We all know this is a very political issue,” Case said, “and based on the outcome of the election, it might change, but right now, this is set to go active Jan. 1, 2014.”

In the meantime, the temporary high-risk pool exists as a bridge to cover uninsured people with pre-existing conditions until the ACA provision takes effect.

Case said the temporary high-risk pool is not designed to provide insurance for low-income individuals and families, who would qualify for Medicaid and/or Medicare.

“This is designed for people who, based on their income, could afford insurance, but can’t get it on the commercial market because of a pre-existing condition,” Case said. “You can be excluded from having medical insurance for being just a little overweight. The commercial insurance carriers are very cautious about signing on anyone with a pre-existing condition.”

Of the estimated 650,000 Oklahomans without medical insurance, “not all of those people are living in poverty,” Case said.

In fact, she said, the majority of uninsured Oklahomans earn too much money to qualify for Medicaid or Medicare, and are uninsured because of pre-existing medical conditions or inability to pay premiums for commercial insurance.

She said only about 250,000 of the 650,000 uninsured people in Oklahoma qualify for Medicaid, “and that leaves a ton of people who are not low-income who don’t have insurance.”

Oklahoma made its own effort to insure those with pre-existing conditions long before “Obamacare” crossed the horizon. Lawmakers implemented a state high-risk insurance pool in the late 1990s, a plan that still is in effect.

But, the state high-risk pool comes with a higher price tag for the insured — in many cases, the premiums are twice as much as the temporary high-risk pool.

The ACA provisions anticipated customers’ desire to depart the more expensive state plan in favor of the cheaper, federally funded temporary high-risk pool.

Case said federal law prohibits the insured from “jumping ship” and leaving state programs to enroll directly in the ACA-mandated pools.

In order to deter this, people must have been without any health insurance for at least six months before they can sign up for the temporary high-risk pool.

Still, the costs of the program have surpassed the original budget, even though fewer people have signed up than originally planned.

Case said the ACA provisions planned for 300,000 to 350,000 people to sign up for temporary high-risk pools, also called Pre-existing Condition Insurance Plans.

Only about 100,000 have signed up nationwide. Enrollment in Oklahoma likewise has fallen below expectations.

But, Case said, the cost of covering those who have signed up has been higher than expected, because “the people joining the pool were so very sick, and their claims were so catastrophic.”

The federal government originally allocated $60 million to implement Oklahoma’s high-risk pool. That figure has since ballooned to $77.64 million to cover about 1,400 Oklahomans until the ACA guidelines take effect in 2014.

While the cost of the high-risk pool is significant, supporters contend the cost of leaving people uninsured is higher, and ultimately ends up being covered by taxpayers and members of commercial insurance plans.

“When a patient shows up in the emergency room a complete train wreck because they’ve never had insurance and never had health care, it ends up costing more and is worse for that patient,” said Kyle Whitehead, owner of Evans Drug Center and a board member for Oklahoma Health Insurance High Risk Pool. Whitehead co-sponsored Case’s talk in Enid at Autry Technology Center, along with Chad Caldwell, executive director of Hospice Circle of Love.

“It’s a lot better for everyone if we can get that person covered before that,” Whitehead said, “so they’re healthier, so they have better outcomes and it’s better for medical professionals.”

Whitehead said he and Caldwell wanted more people to be aware of the temporary high-risk pool.

“We’re all Enid people, and as members of the community, we know there are groups of uninsured people out there, and we just wanted to get this message out there,” Whitehead said. “It helps the hospitals, it helps the patients ... it helps the whole community.”

Caldwell echoed the public service value of Case’s presentation.

“If we can do something that benefits the community ... that’s why we exist,” Caldwell said. “Whether it’s the health care professionals or insurance providers, when Enid benefits, we all benefit, and that’s why we’re here today.

“I think one thing we have to overcome is, there are a lot of people who don’t have insurance and don’t know about the resources available to them. One of the worst things, something we’re trying to avoid, is the situation where someone is not getting the care they need because they’re not aware of the resources available to them.

“I think most people want to be able to pay for their medical care. If this is a way we can improve their care, and relieve some of that financial burden for the health care providers, then it benefits everyone.

“There’s no such thing as totally free health care. Somebody has to pay for that, and the overall health care system works better for everyone if as many people as possible are paying into the system.”

For information on the Oklahoma Temporary High Risk Pool, go to www.bcbsok.com/ohrp or call (877) 885-3717.

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