Federal High Risk Pool Reaches Oregon

July 14, 2010 -- It’s official. The federal high risk pool gets under way in Oregon on Aug. 1, and people can begin applying immediately.

 

Anyone with a pre-existing medical condition who’s been uninsured for the last six months is eligible as long as they’re a U.S. citizen. The medical benefits will not only be richer than OMIP – the state-run pool – but the monthly premiums will also be less expensive, according to Tom Jovick, administrator of the Office of Private Health Partnerships. Jovick signed the official documents yesterday.

 

Monthly premiums will cover 50 percent of medical costs; the federal subsidy the remainder. Over the next 3 ½ years the feds are expected to pour $66 million into Oregon as part of a $5 billion package that will benefit 31 participating states.  

 

With those dollars, the state will have enough money to cover 2,000 people, said Jovick, who expects the pool to reach capacity by next April. Then, prospective members can either join a waiting list or sign up for OMIP.

 

When the federal dollars run out, officials won’t have the option of shutting down the pool and switching members to OMIP, which they had originally been told. That option would have let the state enroll twice as many people with the same resources.

 

“We have to make certain the pool is running, and we have people enrolled through 2013,” Jovick said. “The feds were afraid of a lawsuit if the pool was shut down, and we had to turn people away.”

 

There’s yet another reason the federal pool can’t be shut down, which officials have been reluctant to discuss, Jovick admitted. “If they shut down the pool and there was only enough money to pay the claims, it would be obvious that the federal government hadn’t allocated enough money for the federal pool, and they didn’t want that to be obvious,” he told the OMIP board on July 12.

 

However, it's already clear enrollment must be capped. And it's expected to fill fast. To keep tabs on the revenue flow, Jovick intends to analyze enrollment and expenditures every month, consulting with federal officials.  

 

“They’re guaranteeing us that if all of a sudden we have several hundred thousand dollars in claims and there’s not enough money, we won’t be on the hook,” Jovick said. “Where they’ll find the money I don’t know; they’ve talked about building their own reinsurance fund.”

 

People joining the federal pool can choose from a $500 or a $750 deductible plan and pay a maximum of $5,950 in out-of-pocket expenses. They won’t be charged a copayment for influenza vaccinations, diabetes drugs and supplies, evidence-based generic drugs for high cholesterol, blood pressure or antidepressants or a membership fee to join Weight Watchers.

 

Premiums will range from $221 to $714 each month, based on age range and plan choice. 

 

Over the next few years, Jovick anticipates that 50 percent of people who would have joined OMIP will be eligible for the federal pool. Regence BlueCross BlueShield will administer that pool, handling eligibility, enrollment, benefits, claims and case management.

 

Currently insurance assessments cover 50 percent of the state-run pool; monthly premiums pick up the remainder. This year those assessments are expected to reach $80.5 million and would have soared to $96.2 million in 2011, $110.3 million in 2012 and $118.4 million without the federal pool.

 

Of the $66 million allocated in federal funds over the next 3 ½ years, close to $1 million is expected to be spent this year; $14.5 million in 2011, $20 million in 2012, $22.5 million in 2013 and the remainder in 2014.

 

Despite lower insurance assessments, Jovick doesn’t expect those numbers to influence overall premium rates. “Our assessment may drop a little,” he said. “But what really drives premiums isn’t the assessment – it’s medical inflation – medical costs – and it’s certainly not going down.”

 

For related articles on high risk pools click here.

 

For more information about OMIP or the federal high risk pool, click here.