Michigan set to start high-risk health insurance pool

8/29/2010

LANSING, Mich. — Michigan is set to launch a subsidized insurance pool for people who haven't been able to get coverage because of a pre-existing health condition, but it's not clear if the program will be big enough to handle everyone who wants to buy in.

Enrollment begins this week for a temporary program that will subsidize insurance coverage for an estimated 3,500 people with chronic conditions such as diabetes, kidney failure, certain forms of cancer and other ailments. The high-risk pool is part of the federal health care overall approved by President Barack Obama and Congress earlier this year.

The program is available only to those with pre-existing health conditions who have been uninsured for at least the previous six months, including those that have been denied coverage for health reasons.

Officials say they aren't sure how many people in Michigan fit that description. It may be significantly higher than 3,500, based on Michigan's overall number of uninsured.

“We don't know how long it will take for the spots to fill up,” said Scott Wilkerson, president of Physicians Health Plan of Mid-Michigan, the health plan selected to administer the program. “Only time will tell that.”

The Lansing-based organization, an affiliate of Sparrow Health System, officially begins enrolling participants Tuesday although calls already are coming in. Coverage is expected to begin Oct. 1.

The temporary health care pool is scheduled to operate until 2014, when federal law requires all insurers to accept individuals regardless of pre-existing conditions.

The new Michigan program will be subsidized by an estimated $141 million in federal grants. The rest of the cash is supposed to come from the people enrolled in the program, including monthly premiums ranging from $182 for those between 19 and 24 to $687 a month for those in their early 60s.

Participants in their late 20s can expect to pay about $240 a month in premiums, while those in their late 40s would pay $350.

Copays in the program will be $20 for a primary care doctor's office visit, $30 for a specialist and $100 for emergency room visits. Generic prescription copays should be around $10, while brand name drugs could have out-of-pocket costs of $30 to $50.

Plan administrators say the coverage will be more comprehensive and in many cases less expensive than typical Michigan policies for individuals. Many of those who will be in the plan aren't able to get commercial coverage at any price because they're so expensive to insure.

“Michigan residents who have been denied care because of a pre-existing condition will now have another chance for affordable coverage and the peace of mind that comes with it,” Gov. Jennifer Granholm said in a statement.

Physicians Health Plan administers the program through contracts with the federal government. Michigan will have regulatory oversight through its Office of Financial and Insurance Regulation.

The state has an estimated 1.2 million uninsured people overall, but it's not known how many of them have preexisting health conditions that have excluded them from coverage.

A policy committee serving U.S. Senate Democrats has estimated that up to 141,753 uninsured Michigan residents with pre-existing conditions could have affordable coverage options because of the federal health overhaul.

A report earlier this year from Families USA, a health care advocacy group, estimated that nearly 1.9 million Michigan adults under age 65 had a pre-existing health condition that could lead to a denial of coverage. But the report didn't say how many might actually be uninsured.

Social service agencies are waiting for more details and program participation rates to emerge.

“But it is important the state is moving forward to cover more people,” said Judy Putnam of the Michigan League for Human Services.