Ventura County Star -

Aug. 10: The chance of health coverage after eight years of being labeled uninsurable, it's the numbers that stress out the Newbury Park real estate agent who once had liver problems. One of the first waves of federal healthcare reform will sweep into California sometime in September when a new government insurance program begins for people who can't get coverage because of pre-existing conditions. Applications for the program, funded by the federal government and run by California's Managed Risk Medical Insurance Board, will be accepted later this month.

In Ventura County, premiums for the program will range from $127 for children 14 and younger to $720 for people 60 to 64. Mars, who is 55 and was last insured before she had two large abscesses removed from her liver, would face monthly premiums of $564. "Crazy," she said. An advocate of reform, Mars still plans on applying for the program though she's not sure she can afford it. "I'm happy that at least there's an option for people."

The program is aimed at people who have been uninsured for at least six months and have a health condition that blocks them from private insurance. It will be funded by $761 million in federal money over three-plus years and is designed as a bridge to 2014, when reform will mean people with pre-existing conditions can no longer be denied coverage or be charged more for it.

The rates incite sticker shock for some, especially those 50 and older. Janelle Endy of Simi Valley is 59, has a thyroid condition and has been unemployed for more than two years. The $564 premium won't come close to representing an option.

"Oh no. I'm not even collecting unemployment," she said, noting her benefits expired. For others, the costs are relative. Michelle Vickers, a 25-year-old Ventura hairstylist, suffered problems related to lupus and ended up in a hospital for several hours with a bill that even after being reduced totaled about $5,000.

If she qualifies for the new high-risk pool, her premium would be $180 a month. That intrigues her. "If it did cover what I needed that would be totally fine," she said. The coverage will be comprehensive and will include an annual deductible of $1,500 and a yearly out-of-pocket maximum of $2,500, said Jeanie Esajian of the California Managed Risk Insurance Board, which will administer the program.

The prices may seem high but they comply with the federal reform law asserting they can't be higher than the standard rate charged individuals in the commercial market, she said. Setting prices lower would have meant that fewer people would have been covered, Esajian said. Analysts estimated as many as 25,000 Californians will be covered in the pool at any one time. That compares to a maximum of 7,100 people covered in the state's existing high risk pool.

In that state program, a 42-year-old Ventura County resident pays a premium of $657.50. In the new federal program, the premium for a person the same age would be $304. "I definitely think it will help people," said Gerald Kominski, associate director for UCLA Center for Health Policy Research, noting the current insurance system often blocks the people most in need of insurance from getting it. The new program won't come close to ending the problem, but it will help.

"I think these high-risk pools are a good bridge and a good first step," he said. The insurance will help the middle class, including business owners who can't afford coverage because they have a condition such as diabetes, said Lisa Safaeinili, executive director of the Westminster Free Clinic in Thousand Oaks. But the prices will mean it likely won't touch the growing flood of low-income people who currently rely on free clinics, low-cost county programs and similar safety nets, she said. "This will still be unattainable," she said.
 


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