Affordable Care Act
2:59 pm
Fri November 8, 2013

Patients In 'High-Risk Pools' Must Scramble To Get Insurance

Originally published on Fri November 8, 2013 3:27 pm

In an interview with NBC News last night, President Obama apologized to Americans who are losing health insurance plans that he had promised they could keep under the Affordable Care Act.

At least 3.5 million Americans have received cancellation notices from their insurance companies because their plans don’t meet the standards of the law known as Obamacare.

There is a second, smaller group of people that also faces losing coverage — the 300,000 people in what are called “high-risk pools ” run by states and the federal government.

These people suffer from severe chronic diseases, such as cancer, heart failure, and kidney disease, and were turned down for health insurance before the Affordable Care Act was passed.

But many of these high-risk pools are being phased out next month as the ACA kicks in, potentially leaving some people in the lurch if they can’t get enrolled in a health insurance plan in time.

Guest

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Transcript

MEGHNA CHAKRABARTI, HOST:

It's HERE AND NOW. In an interview with NBC News last night, President Obama apologized to Americans who are losing health insurance plans that he had promised they could keep under the Affordable Care Act.

PRESIDENT BARACK OBAMA: I am sorry that they, you know, are finding themselves in this situation based on assurances they got from me. We've got to work hard to make sure that they know we hear them and that we're going to do everything we can to deal with folks who find themselves in a tough position as a consequence of this.

CHAKRABARTI: At least three and a half million Americans have received cancellation notices from their insurance companies because their plans don't meet the standards of Obamacare. Well, there's another 300,000 people who could also lose coverage. They suffer from severe chronic illnesses such as cancer or kidney disease and were unable to buy health insurance before the Affordable Care Act became law.

So states and the federal government created what are called high-risk insurance pools to cover these vulnerable people. Those insurance pools are now being phased out as the Affordable Care Act is phased in. However, given all those problems with heathcare.gov, many chronically ill Americans fear they won't be able to continue essential treatment if they don't enroll in a health plan soon.

Joining us on the line from Oklahoma City is Tanya Case, chair of the National Association of State Comprehensive Health Insurance Plans. And Tanya, what's the latest on how people in these high-risk pools are faring when they try to sign up for health insurance?

TANYA CASE: What we are hearing in the last couple of days is that there's daily improvements in heathcare.gov, and we are hearing that people are beginning to get enrolled. What I have always stressed and what many of the state executive - high-risk pool executive directors stress to their members is that there are many ways or many things that they can be doing right now to get ready to get enrolled.

And we also remind them that they can enroll over the phone. It takes a while to shop for a plan because our high-risk pool members need to make certain that their physicians, their hospitals are in their plan because they use health care frequently, and they have very close relationships with their health care providers.

Also, they have to do a lot of research into the plans' pharmacy benefits because they use very high-dollar drugs, and many of them use specialty drugs. So we've impressed upon them that they must make certain what the plan covers in regards to the pharmaceuticals and make sure that they choose a plan that covers their pharmaceuticals at a rate that is going to allow them to be financially viable in whatever their co-insurance remains with that.

CHAKRABARTI: Right, and so the people in these high-risk pools, as we were saying earlier, they have severe chronic diseases such as cancer or kidney disease. And therefore they're in need of continuous coverage. Even a small interruption could be relatively catastrophic for them.

Have you been hearing from people in the pools and what their concerns are?

CASE: Yes, I have definitely heard from our individual members. They're scared. Some of them have said that, you know, if they can't get enrolled, they're going to have to disrupt their treatment because they cannot afford it. We have urged them to talk to the carriers that are offering plans in their - it's typically county by county - to talk to the individual plans, determine the plan that they want and then call the new marketplace number, toll-free number to get enrolled.

And we have found that some people have been successful by doing that.

CHAKRABARTI: If I may, that sounds like an awful lot of work for people whose primary concern is probably their day-to-day existence.

CASE: Yeah, this is a very difficult decision for our members. It's not something that they can do in, you know, five or 10 minutes. It takes them a lot of research, and you're exactly right. And for many of them, you know, they have family members that are helping them with it. Again, we are encouraging them to use, if there are navigators that are located within their community or if they have certified assistant counselors within their community to use them to assist them.

And also, very importantly, if they have a relationship with insurance broker, an agent, we strongly suggest that they work with that agent to help them. Many of the people that have come into the high-risk pools have come into the high-risk pools through the help of a licensed insurance agent, and we strongly recommend that they continue that relationship.

CHAKRABARTI: And finally, people do need to sign up for new plans by the middle of December, I believe, in order to be able to be covered by January 1. What are states doing who have these high-risk pools? What are they doing to help people?

CASE: They are getting a lot of mailings out to their members. Some are doing robocalls. Some are reaching out or considering reaching out to their very high-risk members individually. For example in Oklahoma, those that are over $150,000 of claims this year would be somebody that we know is using a lot of services, and we want to make sure and reach out to them personally to make sure that they get transitioned.

There are some states that are using Facebook, and that seems to be very effective with those states that have a big following on their Facebooks.

CHAKRABARTI: Well, Tanya Case is chair of the National Association of State Comprehensive Health Insurance Plans. Thanks so much for your time today.

CASE: Absolutely. Hopefully people can, as things progress, will be able to get enrolled. Transcript provided by NPR, Copyright NPR.

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