Wednesday, January 28, 2009

Voted Off the Island

If you have ever watched the reality shows where votes are taken and someone is voted off the island, you can imagine how Jeanne Sather felt.

Or if you are the last one to be picked for a schoolyard game of kickball, then you understand the feeling.

No one wants to play with you. It is an empty feeling that takes a while to get over.

Since Jan. 1, a third of the 82 members of the Washington State Health Insurance Pool whose coverage was terminated have been reinstated after they belatedly provided proof of eligibility.

In 3 weeks time, 82 of Washington state's sickest lost their economic lifeline . . . health insurance.

The risk pool is for those who have no other options.

With premiums that can top $20,000 a year, patients don't exactly clamor to join the state's high-risk health-insurance pool — a public insurer of last resort for patients with cancer, AIDS and other serious diseases.

Until you or someone you know is sick or seriously injured, you probably don't know how much health care, and health insurance, really costs.

Some cancer treatments can run $8,000 per month for a single monthly treatment.

That's scary stuff.

Jeanne Sather, a Seattle writer and blogger who has advanced breast cancer, said she lost — then regained — her coverage because of a paperwork snafu. Sather said she twice had to send proof of her Medicare coverage but still ended up receiving a cancellation notice.

A seasoned patient's advocate, Sather fired off e-mails to both the high-risk pool and the state Insurance Commissioner's Office. She quickly got her coverage restored — but not before she worked up a fury.

"You have to remember that people like me are sick," Sather wrote in one e-mail. "So making trips to Kinko's to make copies uses up precious energy and time. I deeply resent being asked to do something like this."

This can happen to anyone, but when it is a government run plan, funded (at least in part) by taxpayer dollars, it really gives you pause about the future of public plans.

By law, the high-risk pool is open only to residents of the state. It also must ensure that members who have dual coverage with Medicare tap those federal benefits first. Last year, a state audit recommended that the pool obtain proof of eligibility from all its 3,300 members.

Only 3,300 members state wide. That is a bit surprising.

The high-risk pool provides coverage for people who can't buy individual insurance from Regence BlueShield, Premera Blue Cross, Group Health Cooperative and other commercial insurers. Washington permits insurers to screen out the sickest 8 percent of the applicants. In return, the insurers pay a subsidy — totaling nearly $40 million last year — to help offset the cost of operating a separate pool.

Each state that operates a risk pool has different criteria. In most, if not all cases, funding is provided through member premiums, taxes and carrier assessments.

In other words, everyone shares in the cost.

Risk pools are a good thing but, like anything else, are subject to abuses. States must constantly audit to make sure the pool remains solvent for current and future participants.
blog comments powered by Disqus