High risk pool needs addressed

January 4, 2011
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By December, a little more than 100 people were enrolled in the new high-risk pool for health insurance, created under health care reform, Physicians Health Plan of Michigan President Scott Wilkerson said.

That is far short of the 3,500 needed to use the entire $141 million in federal money allotted to Michigan for the program, which extends through 2013.

So PHP teamed up with the Michigan Health and Hospital Association to suggest a novel idea: ask hospitals to cover high-risk pool premiums.

“The reality is, individuals are receiving care for which, right now, the hospitals are receiving little or no compensation,” MHA Executive Vice President David Seaman said.

“The idea of making a small investment for someone who is chronically ill and unable to obtain insurance and avoid the consequences of uncompensated care is good social policy and fiscal policy, as we look at it.”

Those premiums can range up to $686 per month for adults in their 60s. The federal money, part of $5 billion allocated for high-risk pools across the country in the Patient Protection and Affordable Care Act, subsidizes the cost of insurance for this population.

Wilkerson said it’s been tough to inform people about the program, now called Health Insurance Program for Michigan. Enrollment began in October.

The high-risk pool is a new concept in Michigan, where Blue Cross Blue Shield of Michigan for decades has been required by state statute to offer health insurance to everyone, regardless of health status. Now the federally backed pool is another option.

People are confused by the federal participation, he said, and think the insurance is free under health care reform when it is not. Mostly, they just can’t afford another monthly bill, he said, even though buying into HIP is cheaper than facing hospital and doctor bills.

Health insurance for these individuals could be expected to cost tens of thousands of dollars per year in premiums, and the federal money is being used to cut that cost, Wilkerson said.

“We would expect this to cost to somewhere in the neighborhood of $30,000 on average, so we think that’s a pretty good value. But if you’re a Michigan citizen, that’s still pretty expensive. We’re trying to do a lot more education to help people understand the value.”

In July, PHP and Priority Health of Grand Rapids were both awarded contracts to run the high-risk pool in certain counties. But the Legislature declined to authorize funding, and Priority Health pulled out in favor of PHP.

Wilkerson said PHP has tried marketing ploys to reach this narrow population. To be eligible, a person must be a Michigan resident, U.S. citizen, have been denied insurance within the past six months and have been uninsured for six months.

He said HIP has been advertised in newspapers, through public service announcements, on the Internet and even on closed-circuit television in Secretary of State offices. HIP now is turning to organizations such as the Michigan State Medical Society, the Michigan Osteopathic Association and the MHA.

In a weekly newsletter this fall, the MHA urged hospitals to consider paying HIP premiums for their qualifying patients.

“It’s sort of territory that’s largely been unexplored,” Seaman said. “We are encouraging our members to evaluate and think about it.”

For more information, visit www.hipmichigan.org

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