Newspaper article The Florida Times Union

High-Risk Insurance Pools to Cover Chronically Ill Starting July 1; but Analysts Warn That Federal Officials Should Take Heed of Florida's Experience with Similar Coverage

Newspaper article The Florida Times Union

High-Risk Insurance Pools to Cover Chronically Ill Starting July 1; but Analysts Warn That Federal Officials Should Take Heed of Florida's Experience with Similar Coverage

Article excerpt

Byline: JEREMY COX

If the federal government's plan to offer moderately priced, last-resort health insurance to Americans with chronic illnesses sounds familiar to Floridians, it is.

The high-risk insurance pools, one of the key elements of the new health reform law, are set to begin enrolling people on July 1. The regional plans are intended to cover patients who ordinarily would be all but disqualified from buying individual coverage because they have pre-existing conditions.

Federal officials should take heed of Florida's experience with high-risk insurance, say analysts who remember the long-defunct initiative. Plagued by exorbitant medical costs and skimpy revenue, the Florida Comprehensive Health Association, by order of the Legislature, stopped accepting new enrollees in 1991, eight years after it was created.

"The risk spiraled so you only had bad risk in," said Randy Kammer, vice president of regulatory affairs and public policy for Jacksonville-based Blue Cross Blue Shield of Florida.

The state pool once covered about 7,000 Floridians. Since enrollment was closed, that number has dwindled to a few hundred people as enrollees have died or found coverage elsewhere.

SPENDS MORE THAN IT EARNS

Enrollees' premiums are more than double the standard rate, Kammer said. Still, the cost of care exceeded the amount collected in premiums by about $1.5 million last year. The 600 companies that sell health insurance in Florida, like Blue Cross, pay a portion of the balance based on their market size.

Under the new federal law, enrollees are eligible only if they have a pre-existing condition and have been without health insurance for the preceding six months or more.

The U.S. Department of Health and Human Services has yet to define what it means to have a "pre-existing condition." But if Renee Riker's pernicious skin infection on her right leg opens the door for eligibility, she may walk through.

"We can't afford to have [health insurance], but we can't afford not to have it," the 43-year-old Baldwin woman said.

Two years ago, what she thought was an ant bite on her right thigh turned into a MRSA-like infection that covered much of her leg. At the time, she had Medicaid, a state-federal insurance program for the poor, which covered her more than $100,000 in medical bills. …

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