Funds run low for health insurance in state ‘high-risk pools’

Melina Mara/THE WASHINGTON POST - Virginia resident Maureen Murphy in 2010. Murphy, who suffered a stroke and later was diagnosed with a brain aneurism, benefits from Obama's health care reform law qualifying her for the federal "high risk pool" insurance.

Asked why the administration has not requested additional money from Congress to keep the program open — admittedly a tough sell in the current political and budgetary environment — Cohen said, “My responsibility is to work with the appropriation we have.”

About 129 millionpeople nationwide have a medical condition or prior illness that would make it hard for them to buy their own insurance plan.

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Large numbers of them can and still do obtain full coverage through employer-sponsored plans, which generally do not treat sick people differently.

An additional 215,000 people are insured through separate high-risk pools that 35 states fund through their own budgets — although the policies often do not pay for treatment of the person’s preexisting illness, only covering new illnesses the person may develop.

Between 9 million and 25 million people with preexisting conditions are uninsured, depending on the estimate.

Among those stunned by Friday’s news was a 61-year-old Virginia woman who is battling stage-four breast cancer. The woman, who asked to be identified by her middle name, Joyce, because she wants to keep her illness private, is self-employed and had bought her own insurance for years.

Late in 2010, however, the insurer that Joyce was using pulled out of Virginia. She was healthy at the time. But when she applied to other companies, she was told that because she had been diagnosed with— and successfully treated for — an earlier breast cancer, she was ineligible for coverage.

Joyce said she was unaware of the high-risk pools at the time and remained ignorant of the option even as she was diagnosed with her current cancer. As the disease has progressed, the cost of her treatment has skyrocketed. The latest expense, a 10-week course of chemotherapy that she expects to total about $30,000, as well as additional tests that could top $8,000, has forced her to dip into her retirement savings.

It is only in the past several weeks that Joyce learned of the high-risk pool, and she was on track to finalize her application Sunday.

On Friday, she scrambled to get it in by the unexpected new deadline. She said the computer system appeared to accept her entries, but she will be on tenterhooks until she finds out for sure.

“I feel like the rug has been pulled out from under me,” Joyce said. “On every level, this is just beyond discouraging.”

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