Colorado will receive $90 million in federal money to subsidize health insurance for up to 4,000 people rejected by private insurers because of pre-existing medical conditions, Gov. Bill Ritter announced Tuesday.
The new high-risk pool, a public-private partnership the state is calling GettingUsCovered, will charge the same rate for health coverage that the average, healthy Coloradan pays.
That’s the major distinction between it and Colorado’s existing high-risk pool, CoverColorado, which insures about 12,000 people who have serious illnesses — or even minor medical problems, such as a teen taking acne medication — that prevented them from buying coverage elsewhere.
CoverColorado clients pay about 130 percent of the market rate for insurance. They cannot seamlessly transfer membership to the new program because of a rule that says beneficiaries must have gone without health insurance for at least six months to quality.
The governor and CoverColorado executive director Suzanne Bragg-Gamble emphatically discouraged any CoverColorado clients from dropping out of that program, going without insurance for six months and then signing up for the new insurance plan. The outcome for a seriously ill person to survive without coverage for six months “could be disastrous,” Bragg-Gamble said.
Besides, it’s possible that within the next few months, the new risk pool will be full.
As part of national health reform, the federal government gave states until July 1 to set up insurance pools for those with pre-existing conditions. In states that did not set up a pool, a new federal high-risk pool will take effect.
Colorado has $90 million to spend during the next three years to keep its high-risk pool afloat. The pool is intended to phase out in 2014, when insurance companies can no longer reject people for pre-existing health conditions.
The state pool is a partnership between CoverColorado and Rocky Mountain Health Plans, which will handle claims and billing. The federal money will subsidize the cost of the coverage, which is expected to exceed premium rates charged to patients.
By federal mandate, premiums cannot cost more than what a healthy person of similar age would pay in Colorado. They will range from $115 a month for an 18-year-old nonsmoker in Boulder County to $807 for a 64-year-old smoker in Eagle County. The annual deductible is $2,500, with $30 copays for doctor visits.
Beneficiaries will choose from the Rocky Mountain network of 2,500 doctors and 99 hospitals, said Rocky Mountain Health Plans president Steve ErkenBrack, who called the high-risk pool “a bridge into the post-health care reform world.”
The program eventually might accept more than 4,000 people, depending on how much the initial applicants cost to insure.
“The big question that we have right now is, how much are these people going to cost,” Bragg-Gamble said. “We cannot run out of money.”
State research estimated that of some 700,000 Coloradans without health insurance, about 30,000 would qualify for the new pool. That doesn’t mean they can afford it, however.
Among those who planned to sign up immediately was Karen Lewis, a 50-year-old Denverite who hasn’t had health insurance since her marriage ended two years ago. She has been rejected multiple times because she has diabetes and heart problems.
“It’s been a long haul, a very, very expensive long haul,” she said.
Lewis, who attended the governor’s news conference at the Capitol, recently spent two days in the hospital at a cost of $11,000. She spends $115 to $400 a month on prescription drugs.
“I’ve sometimes cheated a little bit and not taken as much medication as I should,” she said, adding that she would fill out an application “as quick as they put it in my hand.”
To enroll, go to gettinguscovered.org or call 877-779-0387.