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Health plans for high-risk patients attracting fewer, costing more than expected

This year produced a number of winners and losers -- from the tea party and Alaska Republican Sen. Lisa Murkowski to President Obama and the House ethics committee.

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She was discharged two days before Halloween with a $25,000 hospital bill.

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A friend recommended the new high-risk pool. Four days after Thanksgiving, she was approved. It will cover her surgery in January to repair the aneurysm. The plan's premiums, Murray said, are steep - $358 a month even after a rate reduction in January. "I'm in rough financial position, but . . . I can get another job," she said. Without the insurance, "I might not have that opportunity."

Expensive coverage

On the other hand, Will Wilson, 57, of Chicago said he is "really, really, really, really discouraged." After he received an AIDS diagnosis in 2002, he discovered that his insurance at the time paid only $1,500 for medicine each year. His AIDS drugs cost $3,000 a month. He ended up in bankruptcy.

Wilson, a tourist trolley guide, now gets help from the federal AIDS Drug Assistance Program, but he has no coverage for other kinds of care.

Wilson remembers tears streaming down his face in February 2009, the night that he watched Obama vow to Congress, "Health-care reform cannot wait, it must not wait, and it will not wait another year!"

Wilson became an activist for health reform, circulating petitions, going to demonstrations. And the day after the president signed the bill into law, a Chicago Sun-Times column quoted him as saying, "I've had a grin on my face all day" at the prospect of the high-risk pool he could join. That was before the rates were announced in July and Wilson discovered that the premium - nearly $600 a month - "was almost as much as my rent. It was like, no way! I was floored."

The law contains rules to make the high-risk pools more affordable than older ones that many states have run; the new ones cannot charge more in premiums than the average premium for other individual insurance in a given state. But "the individual market is expensive," said Jean P. Hall, a University of Kansas researcher studying the new plans. "From my perspective, it is not a good match for people who have expensive conditions."

HHS has made some changes for 2011 in the federal plan on which 23 states and the District are relying. It will have somewhat lower premiums and two new options with varying deductibles, according to Richard Popper, HHS's deputy director for insurance programs.

The agency also is launching a more aggressive marketing campaign, Popper said, focused on states, including Virginia, whose residents have not had any kind of high-risk pool in the past. And the Social Security Administration has agreed to tell everyone it approves for disability benefits about the new health plans.

Among the 27 states with their own plans, 17 have submitted changes for HHS to approve so they can lower premiums, adjust other costs or alter who is allowed to join.

And they are doing more marketing. Michigan is running Internet ads through Google. North Carolina is advertising on billboards across the state and on cable television.

Fretting about challenges

Whether the marketing and plan adjustments will translate into more customers remains unclear. Cecil Bykerk, the executive director for the new plans in Montana, Iowa and Alaska, said some people are wary over whether the health-care law - and the high-risk pools it has created - will last. "I think there is a lot of concern in the public with all the [federal court] challenges and all the political rhetoric about appeal," he said.

Montana is one of a few states in which the medical bills from those who have joined are huge. New Hampshire's plan has only about 80 members, but they already have spent nearly double the $650,000 the state was allotted in federal money to help run the program, said J. Michael Degnan, its director.

The spending, Degnan speculated, might slow down if it turns out that the early bills reflected a burst of pent-up need for care. HHS agreed to give New Hampshire more money, he added.

When the law was passed, proponents of the special health plans feared the $5 billion would run out before 2014. Today, HHS's Popper says of that financial help: "We want to use it - make it last but also use it to effectively to get people covered."


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