Providers jump in to support high risk pool

June 17, 2011
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Those in the business of providing medical care got together last week at the Fred and Lena Meijer Heart Center on Spectrum Health’s downtown campus to urge uninsured residents to enroll in a relatively new statewide health insurance program.

The plan is known as HIP Michigan and is a temporary high-risk pool created by the Patient Protection and Affordable Care Act. HIP Michigan offers what it says is affordable coverage to persons whom most private insurers turn away because of pre-existing conditions.

“This is about access to health care and it is a program that uses some of the federal dollars that come out of the president’s health bill to get insurance to people who have had trouble in the past because of pre-existing conditions,” said Steven Heacock, senior vice president of community relations for Spectrum Health.

“With these new products, we can reduce premiums to those being covered by up to 40 percent,” said Scott Wilkerson, HIP Michigan administrator. “It does cover pre-existing conditions and preventative care.”

HIP Michigan accepts a wide range of pre-existing conditions that stretch from AIDS to Wilson’s disease, and includes cancer, diabetes, epilepsy, heart disorders, kidney failure and many others.

The gathering last week unveiled new and reduced HIP Michigan monthly premiums that were recently approved by the U.S. Department of Health and Human Services. For instance, the least costly premium right now for 19-24 year olds with a $1,000 annual deductible is $181 per month, but with the blessing of HHS, the monthly price drops to $130 for those who chose the $2,500 deductible, and to $109 a month for those who go with the $3,500 deductible.

Premiums also will fall for those on the other side of the age spectrum. Right now, the most expensive premium for ages 60-64 is $686 a month with a yearly deductible of $1,000. If they move to a $2,500 deductible, the premium drops to $494 a month, and to $415 a month if they chose the $3,500 deductible.

Coverage includes doctor visits, prescription drugs, emergency care, hospital coverage, home health care, wellness services and behavioral services. Co-pays are $20 for an office visit, $30 for a specialist, and $100 for trips to the emergency room.

“It does provide peace of mind about going to a doctor with an insurance card,” said Wilkerson.

HIP Michigan can offer these rates because the federal government is giving the program $141 million from the PP&ACA through the end of 2013, when the plan ends and is replaced by the legislation’s health insurance exchanges that go online in 2014. But there is an election next year and virtually every Republican running for Congress and the presidency has said they will repeal the reform bill they refer to as “Obamacare” and “a government takeover of health care.”

If Republicans win and the PP&ACA is dismantled, will HIP Michigan receive its full federal subsidy in 2013, its final year?

“I don’t know,” said Heacock. “And part of the struggle with health care today is, of course, this uncertainty because the federal government is very important. It’s a big part of the revenues through Medicare and Medicaid and other programs. But as of today, this program exists and it’s something that can help people in Kent County to get care where they might not always get it.”

Andrew Farmer, associate state director of AARP Michigan, felt it was unlikely that the Act will be repealed and harm HIP Michigan, even though it is being attacked in the courts and in Congress. “The Republican House has done what it could this time around, but it wasn’t an effort that had any credence because everyone knew it wasn’t going to pass the full Congress, let alone get signed by the president,” he said.

“So repeal is a very illusory kind of concept for the short term and for the foreseeable future. So there is nothing stopping this program now. People should be taking advantage of it if they can find it affordable for themselves,” he added. “Real people are going through hideous losses and catastrophic struggles, and here is an opportunity right now to get some help until these new exchange markets come on 2014. That’s where the focus needs to be. Everything else is just speculation.”

David Seaman, executive vice president of the Michigan Health and Hospital Association, pointed out that HIP Michigan isn’t only cost effective for individuals; he said it’s also good for hospitals that wrestle with uncompensated care. He said the plan can help reduce the mounting debt that is plaguing the provider industry and certain hospitals. “Ensuring access to care is a priority — perhaps the top priority — for hospitals in Michigan,” he said.

But there isn’t an apparent long-term benefit from HIP Michigan for non-medical employers.

“I don’t think so, in part because of its temporary nature and it’s hard to know what continues (after it). I think it’s really viewed as a stopgap. Certainly though, employers through their human resources departments may know of people who should be applying to this program, and they certainly should refer them to it,” said Heacock.

HIP Michigan is administered by HMO Physicians Health Plan of Mid-Michigan, which has contracted directly with HHS and is owned by Sparrow Hospital in Lansing. The Michigan Office of Financial and Insurance Regulation has regulatory oversight of HIP Michigan.

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