Chronically ill await provision of law

Holly Knight, at home in Point Place with her dogs Monty, left, and Cho, says her retirement planning did not allow for the jump in medical coverage costs. She must wait two years to be eligible for Medicare.

Holly Knight started financially planning for retirement long before making the move this summer.

Calculations that the Point Place resident received last year showed she would need $500 to $550 a month to continue health-insurance coverage through COBRA from her last job, as communications director for Sisters of the Immaculate Heart of Mary in Monroe.

The plan allows Ms. Knight, who has colitis, to get a $600-a-month prescription for $40.

Yet insurance costs have gone up, so that coverage now costs Ms. Knight $756 a month. Efforts to find an option in an era of federal health-care reform did yield an alternative after her initial application for a $469-a-month plan was denied, but the offer would have cost $1,200 a month, more than twice what she had budgeted.

"I really had this planned out pretty well," said Ms. Knight, 63. "It was really a very hard kick in the gut when I got the denial. It was a wake- up."

Some key tenets of the Patient Protection and Affordable Care Act -- including insurers no longer being able to refuse coverage for pre-existing conditions -- have yet to fully go into effect. Others, such as requiring everyone to have health insurance, are being challenged in Ohio, Michigan, and many other states.

As the federal law enacted last year stands, it will not be until 2014 before insurers cannot deny coverage based on medical conditions.

Affordable Insurance Exchanges, state-based competitive marketplaces where individuals and small businesses can compare and purchase health-insurance plans, will not open until 2014, either.

Through the law, however, children with pre-existing conditions cannot be denied coverage.

Ohio and Michigan also have pre-existing condition insurance plans, which provide coverage options for adults who have been uninsured for at least six months and who either have a pre-existing condition or have been denied insurance because of a health condition.

Last week, the U.S. Department of Health and Human Services proposed a framework to assist states in building insurance exchanges.

The government expects the exchanges will drive down insurance costs as companies seek to compete for business.

Ohio and Michigan have received federal grants to help plan and operate exchanges that can be developed with the federal government or by states themselves.

More than half of health-insurance executives say their companies will compete in the exchanges, a new market that initially will create $60 billion in annual premium revenues and grow to nearly $200 billion by 2019, according to a report released last week by PricewaterhouseCoopers LLP's Health Research Institute.

That will be too big a market for insurers to ignore, and because consumers will be able to compare health-care plans, costs are likely to remain competitive, said Jinn-Feng Lin of PricewaterhouseCoopers in Chicago, who is one of the report's authors.

"It will give these new customers more power and more choice," she said.

When exchanges open in 2014, about 97 percent of participants are expected to be those who were uninsured, according to the PricewaterhouseCoopers report.

The report incorporates a nationwide survey of 1,000 consumers and 153 health insurance executives.

Nearly one-third of insurance executives said their companies are considering competing in exchanges, while17 percent will not participate, according to the report.

Paramount Health Care, ProMedica's insurance arm, is awaiting more information about exchanges, such as whether regional insurers will be included, a spokesman said.

Exchanges can be local, regional, or operated by a nonprofit organization, depending on what each state decides, according to Health and Human Services.

The department seeks feedback from state officials and others on its proposed rules.

Such an exchange could have helped Point Place's Ms. Knight, who plans to try again to find a health-care plan that fits within her budget.

Ms. Knight said she is going to ask her doctor about whether financial assistance exists for the colitis medication she uses.

She said the medication has proven the most effective in controlling the bowel disease that causes inflammation and ulcers, a condition she has had for 25 years.

An alternative would be to buy a health-care plan that covers a less costly, less effective drug.

Ms. Knight, who questions why her prescription medication costs less in Canada, will not qualify for Medicare until she is 65.

She has planned to start selling her line of hand-carved jewelry next month to help cover expenses for a supplemental insurance plan.

"I'm stuck," Ms. Knight said. "Now I know why people go to Canada to buy drugs."

She added: "If I don't have my meds, I will waste away."

Contact Julie M. McKinnon at: jmckinnon@theblade.com or 419-724-6087.