Ohio's High-Risk Health Coverage Program to Stop Accepting Applications

February 22, 2013

From The Plain Dealer
By Diane Suchetka

CLEVELAND, Ohio -- Beginning March 2, Ohio residents can no longer buy high-risk health insurance from the state's program for people with heart failure, cancer and other pre-existing conditions.

The federally funded insurance program was designed to provide coverage for people who have dozens of health conditions, including depression, diabetes, HIV/AIDS and pregnancy. Insurance is expensive for those patients and, in some case, companies refuse to cover them.

On Feb. 15, federal officials asked all states to stop accepting applications for the high-risk insurance by March 2. That's because the program is quickly using up the $5 billion Congress allocated for it in 2010.

By the end of 2012, more than 103,000 people across the country had enrolled and the program had spent $2.4 billion. The average per-person cost to the program was $32,108 in 2012 and varied widely by state, ranging from $4,276 to $171,909.

The program will continue to insure current enrollees, including 3,600 in Ohio, until Jan. 1, 2014, as long as they pay their premiums. Jan. 1 is when a health care reform provision kicks in that bans insurance companies from discriminating against those with pre-existing conditions. The law also says insurers must charge sick people and healthy people the same premiums.

To be eligible for Ohio's high-risk health insurance program a person must:

  • Be a citizen or national of the United States or lawfully present in the United States;
  • Be an Ohio resident at the time of application;
  • Be uninsured for 6 months prior to the date of application;
  • Not be eligible for coverage under the federal Medicare program, the Ohio Medical Assistance Program, the Ohio Children's Health Insurance Program, or an employer sponsored group health plan unless subject to a mandatory initial waiting period, and;
  • Have a qualifying pre-existing condition as evidenced by a denial of coverage by two insurers, or documentation from a health professional of a qualifying pre-existing condition. A list of qualifying pre-existing conditions can be found at tinyurl.com/ohiopre-existingconditions.

"It's just very sad that the program is being closed to new enrollees," said Kathleen Gmeiner, project director of Ohio Consumers for Health Coverage.

Gmeiner says she knows of one woman who lost her coverage in November and is going without any insurance because of the six-month waiting period for the high-risk program.

"I just wish there was something we could do for people like her," she said.

Stories like that are why Gmeiner is calling on U.S. senators and representatives, especially those from Ohio, to fund the program until the end of the year.

"It's really in Congress's lap to try to make this work," she said.

Ohio Lt. Gov. Mary Taylor, who heads the Ohio Department of Insurance, said the suspension of the program is a sign that health care reform, often referred to as Obamacare, can't continue to work.

"These developments represent the concerns I have voiced over the past two years about what lies ahead for consumers," Taylor, a Republican, said in a written statement.

"Just as the high-risk pools have proven too expensive for the federal government to support, Obamacare seems destined to lead us down the same path of unsustainability."

But federal officials made clear back in 2010, when the program began, that they might have to cut off applications if money ran out and that they wouldn't know if or when until they saw how many people applied for the insurance.

And they're defending what is more formally known as the Affordable Care Act.

"The health care law will finally give Americans with pre-existing conditions guaranteed health care that ensures they get treated when they get sick, instead of letting their health conditions worsen and become more expensive to treat," a spokesperson for the Centers for Medicare and Medicaid Services, which administers the program, said this week in an email.

Ohio's high-risk insurance program, run by the nonprofit, Cleveland-based insurance company Medical Mutual, will accept mailed or hand-delivered applications until 5 p.m. March 2, said David Fogarty, Medical Mutual's director for regulatory relations. Those applications should be sent to 17800 Royalton Road, 04-1E-2927, Strongsville, OH, 44136, or dropped off at that office.

The only people who can apply after the deadline are those who had the insurance in another state and move to Ohio.

Federal officials are looking at other ways to save money, too.

They've asked Ohio and the 26 other states that operate their own high-risk insurance plans to look at the possibility of raising co-payments and out-ofpocket maximums. The remaining 23 states and the District of Columbia, which have high-risk plans run by the federal government, raised those costs in January.

To learn more

For more information on Ohio's high-risk health insurance program, call 1-877-730-1117 or go to ohiohighriskpool.com.

Premiums for Ohio's high-risk program are based on age, county of residence, whether the covered person smokes and whether he or she has a $1,500 or $2,500 deductible. They range from about $100 to $900 a month.

The program has been criticized by some, especially those who are older, for being too expensive. In addition, many people are put off by the requirement that they must go without health insurance for at least six months before they can apply.

About 1.5 million people in Ohio do not have health insurance, according to state officials. And more than 17,000 of them qualify for high-risk insurance, according to a study conducted several years ago.