Enrollment Lags in Federal High-Risk Pool

June 23, 2011 – The number of Oregonians enrolled in the federal government’s Pre-Existing Condition Insurance Plan over the past year have fallen far short of expectations.

 

State officials estimated close to 2,000 people would sign up for the plan, which was billed by the White House as a stopgap measure to guarantee insurance coverage for people with pre-existing conditions until federal reforms take effect in 2014.

 

But so far just 840 Oregonians have enrolled in the Federal Medical Insurance Pool, the name given the program in Oregon. Another 13,000 Oregonians have coverage through the Oregon Medical Insurance Pool, which also guarantees coverage. Both plans are administered by the Office of Private Health Partnerships.

 

Tom Jovick, program administrator, said even though the state has not hit its target enrollment, the plan is still spending roughly the same amount of money on medical expenses as though it had nearly twice the number of enrollees.

 

“It turns out the costs are somewhat higher,” Jovick said. “It’s just a real chronically ill population.”

 

The lackluster participation in Oregon reflects a nationwide trend. Officials at the Department of Health and Human Services, which administer the program nationally, had expected more than 200,000 people to enroll. But so far just 18,000 people had signed up nationwide.

 

The federal government allocated $5 billion nationally and $66 million to Oregon, over three years, until 2014 when health insurers will be forced to cover everyone regardless of pre-existing conditions.

 

Each year, Oregon insurers reject around 20,000 individuals.

 

Last month, Kathleen Sebelius, the director of the federal Health and Human Services Department (HHS), announced several changes to the program that should make it more attractive. Premiums could drop by as much as 40 percent in the 23 states where the federal government administers the plan. And qualified enrollees won’t have to obtain a rejection letter from a health insurer. Instead, a doctor’s note will suffice.

 

HHS is encouraging administrators in the 27 states, such as Oregon, which administer their own risk pools to make similar adjustments. Premiums for the federal pool in Oregon are almost identical to that of OMIP. For an individual in his or her 50s, both plans cost around $650 per month.

 

Benefits for OMIP are slightly better, however. The federal program requires that enrollees be without insurance for six months. There’s also a $5,000 drug benefit maximum on the federal program.

 

People aren’t enrolling as expected “probably because it’s just as expensive as everything else,” Jovick said.