Ohio’s High-Risk Insurance Pool Sees Higher Costs

Ohio’s high-risk health insurance pool that began a year ago as part of the federal health care overhaul is facing higher-than-expected costs, which are limiting enrollment.

Nearly 1,800 people are enrolled in the pool, which appears to be one of the most successful in the country and helps cover those who were refused or limited in coverage by private insurers because of pre-existing conditions, The Plain Dealer in Cleveland reported.

Ohio was allotted $152 million in federal funding that was expected to cover 5,000 people until 2014, when the health care changes were expected to be in place.

But as claims are paid, the totals have been much higher than anticipated, said Carrie Haughawout, assistant director for health policy for the Ohio Department of Insurance.

Regulators say that means the program can help less than 2,400 people and, based on an average of 150 new people enrolled each month, it could be full by 2012.

“This is a benefit that we desperately need,” said Kathleen Gmeiner, project director at the advocacy group Ohio Consumers for Health Coverage. “Unfortunately, the high-risk pool simply has fallen short of what it was originally hoped it could do.”

Meanwhile, rates in Ohio’s insurance market have increased, meaning some people enrolled in the pool might have to pay more than the current risk pool rates, which vary from $100 to $700 monthly for one person.

By law, the rates should “somewhat mirror the market in the given state,” Haughawout said. The rates depend on a person’s age and location, whether they smoke, and the amount of their deductible.

There have been a couple of challenges in estimating the rate increase this year, the newspaper reported.

Haughawout said the federal government changed how premiums are calculated _ a move that lowered the rates for new enrollees who are over 55.

Additionally, the rates must be approved at the state and federal levels and have been delayed twice by reviewers’ concerns about rates submitted by Medical Mutual, which administers plans for the risk pool. That has left some people in the pool concerned.

Linda Jean Ellis of Lyndhurst told the newspaper she uses some of her savings to pay her monthly $575 premium but might have to go without insurance if her rates don’t drop soon. The 63-year-old, who couldn’t find work after being laid off as a secretary, said she has carpal tunnel syndrome and other pre-existing conditions that limit her coverage choices from private insurers.

“You don’t have a lot of options,” Ellis said.

Though determining the right rates can be challenging, it’s important because the high risk pools are a “vitally important program” for those who can’t get insurance elsewhere, said Bennett Blodgett, a spokesman for the Centers for Medicare and Medicaid Services.

“We are working with states to make coverage available to as many people as possible,” Blodgett said.

Topics Ohio