Health Insurance Blog

The Texas Health Insurance Pool website gives some history and background to what the pool is and how it benefits Texas residents.

The Texas Legislature created the Texas Health Insurance Pool to provide Texas health insurance benefits to eligible Texans who are unable to get coverage from commercial insurance companies because of previous or current medical conditions. 

The Pool is also an alternative means for individual health insurance coverage which guarantees transferring coverage to qualified residents who lose their coverage under an employer based plan, a church plan, or a state plan.  This is mandated by the federal Health Insurance Portability and Accountability Act of 1996, also known as HIPPAA.

According to an article on news.prnewswire.com the US Census Bureau just published 2006 estimates of health insurance coverage for each county in the nation.  Small Area Health Insurance Estimates (SAHIE) use a variety of sources for their survey models. 

The Centers for Disease Control and Prevention uses SAHIE to support its National Breast and Cervical Cancer Early Detection Program.  Free cancer screenings are offered by the program to low income and uninsured women.

Marcus Plescia, the director of the CDC’s Division of Cancer Prevention and Control in Atlanta says that the health insurance estimates are helpful in determining the level of need for cancer screenings in counties nationwide.  The data permits them to plan various programs and figure out how to allocate resources.

This SAHIE program includes data from various different ages, gender, income, race and low income children.  SAHIE offers a snapshot of those without health insurance that can be extremely valuable to officials as they plan to assist the uninsured.

According to the article “NC high-risk pool an option for many seeking health insurance” by Vicky Eckenrode on starnewsonline.com, there is a new state program to cover high risk applicants to ensure North Carolina health insurance is made available to them.

In 2007, state legislators started the Inclusive Health program.  It’s also known as the North Carolina Health Insurance Risk-Pool and it’s intended to assist people who are struggling to get covered because the industry considers them high risk.  Michael Keough, the program’s executive director says that this is an alternative mechanism to provide affordable health insurance to those high risk applicants.  Enrollment began in January and is up to about 1,600 covered now. 

State risk pools have been in existence for decades.  North Carolina is the 35th state to start this type of program.  The health insurance premiums for Inclusive Health are capped at 175% of the standard risk rate.  In other words, it tops out at 75% more than what a healthy person would pay for a similar policy.  The average age for this program is 50 years old.  This is a great option for many as Congress continues to figure out the health care reform debate.

According to an article on Yahoo sports today, two popular MMA fighters were injured recent MMA sanctioned fights this past week and both were uninsured!  The fighters were Jessica Bednark and Zach Kirk.

Because MMA is such a dangerous sport, and injuries are common, health insurance companies are not anxious to cover participants.  While the promoters of UFC, Strikeforce and Sengoku will apy for the medical expenses that result from injuries in the ring, they are unable to get health coverage for the fighters.

Even if these fighters apply for private health insurance on their own, and indicate their profession as mixed martial arts, the premiums are so high that a fighter can’t afford them, or the health insurance companies won’t cover them at all.

Blue Cross Blue Shield, and AHIP, issued a joint statement opposing President Obama’s proposal to create a government run health plan.  They believe that the creation of a government run health plan would be detrimental to a overhaul of our ailing health system.

In their statement sent to key senators, AHIP and the Blue Cross Blue Shield Association (BCBSA) said that any such program “would thwart the ability of the healthcare sector to implement meaningful delivery system reforms, exacerbate the cost-shift from public programs to consumers and employers in the private market, and destabilize the employer-based system.” The two groups said that more than 100 million Americans would leave their existing private health insurance plan for the proposed federally subsidized health plan.

Both AHIP and BCBSA said they would guarantee health insurance coverage to all families and individuals, including those with pre-existing medical conditions, but only if there is a federal mandate that requires Americans to obtain and hold health insurance coverage. Even so, “rating flexibility based on age, geography, family size and benefit design would be needed to maintain affordability.”

This is a interesting development in the ongoing debate about how to fix the broken health care system in the United States.  This proposal seems like it would make sense for health insurance shoppers if the rates would indeed be affordable.  My gut feeling says that  if health insurance companies are required to cover unhealthy individuals at the same rates as healthy individuals, the healthy people will bear the financial brunt of this compromise.

Walt Williams reports in the State Journal that West Virginia Senator Jay Rockefeller has introduced a bill that is intented to increase health insurance access to those with pre-existing conditions. The Pre-Existing Condition Prevention Act would prevent insurance companies from excluding a pre-existing condition from their coverage. Rockefeller claims that over 130 million Americans suffer from chronic conditions that could lead to individual health coverage being denied them. He also says that this bill is essential to pave the way for universal health care reform at a lower cost.

On the other hand, Walt quotes an industry spokesperson who says that the impact of such denials are heavily exaggerated (although they have far more impact when shopping for an individual health insurance policy on the open market, as opposed to an employer-sponsored health plan that puts a potential policyholder in a larger pool that reduces the risk of any one person with a chronic illness), and that the bill could result in a moral hazard: people will drive up the cost of health care by only buying insurance after they desperately need it.

State legislators in Wisconsin want to tighten individual health insurance regulations, reports Guy Bolton in the Milwalkee Journal-Sentinel. Currently, medical coverage can be denied or taken away if a person fails to disclose any pre-existing medical condition. The bill, which is supported by the state’s Insurance Commissioner, is said to be more consumer-friendly. For example, it would narrow the standard for a “pre-existing condition”: only conditions that were diagnosed by a doctor would qualify. 

Under the law, Wisconsin health insurance companies would also be allowed to look for only pre-existing conditions that occured in the past year, as opposed to being able to look back on whole lifetimes for the purposes of rescinding health insurance. Among other provisions, it would also appoint an independent regulator to examine rejections.

Judith Graham from the Chicago Tribune recently wrote about the Illinois Comprehensive Health Insurance Plan, and its coverage for those individuals unable to buy Illinois health insurance elsewhere. There is a cap on the number of people that can enroll (currently almost 6,000) in order to ensure that its costs are fully covered by state funding and its premiums, which can’t be higher than 150% of what a regular insurance premium costs in the market. This program is reserved for U.S. citizens and legal residents, and has a $2.5 million cap on lifetime benefits, according to Judith.

Currently, Illinois has about a thousand slots remaining in ICHIP’s traditional pool, so it’s worth looking into if you have unsuccessfully attempted to buy individual health coverage or suffer from certain chronic, uninsurable conditions including:

• Juvenile diabetes
• AIDS
• leukemia
• Parkinson’s disease
• multiple sclerosis
• cystic fibrosis

This program is different from the HIPAA plan, which is intended for those who have lost their employer-sponsored health insurance and exhausted their COBRA unemployment insurance.

The top four providers of Florida health insurance recently met to discuss health care under a Barack Obama administration, says Jeremy Cox of the Jacksonville Times-Union. Representatives from Humana, UnitedHealth, Blue Cross Blue Shield of Florida, and Aetna were in attendance.

The insurers believe that President Obama should enact a health insurance mandate for all Americans if, as they predict, he will require insurers to cover individuals with pre-existing conditions. They think that the cost will be prohibitive for carriers otherwise. At the moment, Obama has not publicly supported a mandate, and how exactly one would be carried out is unknown. He has supported a role for the private sector in universal health care, but that role will most likely be a change from the current market.

Instead of the plans Obama and congressional Democrats have proposed for health care reform, the insurance companies would prefer that the government focus mainly on enrolling eligible but currently uninsured individuals in federal-run programs like Medicaid and Medicare, Jeremy says. While the insurance companies agreed that greater coverage is a priority, they claim the task of covering other Americans should be left to them through innovative new plans.

The baby boomer generation (ages 45 to 64) is worried about losing their health insurance, and the current economy is even more cause for concern. Many baby boomers have been either laid off or forced to retire early, and with that comes the loss of their employer sponsored health insurance plan. Meanwhile, they’re not yet old enough to enroll in Medicare.

There are still several options available to people in this age group, says Emily Brandon of U.S. News and World Report. They include:

1. Continuing your former employer’s coverage through COBRA, which they are required to offer unless they go out of business. However, you will have to cover the entire cost of the plan, plus a 2% administrative fee, yourself.
2. Getting on your spouse’s health insurance, if they have continued to work and their employer allows it.
3. Finding another job and continuing to work until you turn 65. Some companies even offer health insurance benefits to part-time employees working as little as 20 hours per week.
4. If you’re lucky to have worked for a firm that offers health insurance coverage to retirees (a steadily declining percentage), take advantage of it. Don’t rest easy, though; many companies are failing to keep their promises and are shifting a higher portion of health care costs onto retired workers.
5. Buy yourself individual insurance. Individual health insurance policies can be expensive, with premiums of over $300 per month according to the Commonwealth Fund. It also may not cover you if you have a chronic, pre-existing condition (and will be even more costly if it does), but if you are relatively healthy it may be your only option. A high-deductible plan could save you money on premiums, although you run the risk of catastrophic out-of-pocket costs. If you go down this route, make sure to research the most affordable health insurance quotes.

There is also the option of forgoing health insurance, but it’s not recommended. You’d either have to cover all of your medical expenses out-of-pocket, or go without some needed medical care.