PORTLAND, Ore. (AP) — With federal and state online health
care marketplaces experiencing glitches a month into implementation,
concern is mounting for a vulnerable group of people who were supposed to
be among the health law's earliest beneficiaries.
Hundreds of thousands of people across the country with pre-existing
chronic conditions such as cancer, heart failure or kidney disease who are
covered through high risk-insurance pools will see their coverage dissolve
by year's end.
They are supposed to gain regular coverage under the Affordable Care Act,
which requires insurers to cover those with severe medical problems. But
many of them have had trouble signing up for health insurance through the
exchanges and could find themselves without coverage in January if they
don't meet a Dec. 15 deadline to enroll.
Administration officials say the federal exchange, which covers more than
half the states, won't be working probably until the end of November,
leaving people just two weeks to sign up if they want coverage by Jan. 1.
"These individuals can't be without coverage for even a month," said Tanya
Case, the chairwoman of the National Association of State Comprehensive
Health Insurance Plans, which represents the nation's high-risk pools.
"It's a matter of life or death."
High-risk pools were created by state legislatures to provide a safety net
for people who have been denied or priced out of coverage. The Affordable
Care Act will forbid insurers from turning away people in poor health. And
while coverage can be purchased outside the exchanges, those who qualify
for subsidies can only get them through a state or federal marketplace.
More than a dozen of the 35 states that run insurance pools for people
with serious medical issues will permanently close their pools within a
month and half. Other states will keep their pools running for a few more
The federal pool covers about 100,000 people and was created in 2010 by
the Affordable Care Act as a temporary bridge until the law fully kicks
in. It will cease to exist at the end of December.
"I'm scared. I'm in the middle of my cancer treatment, and if my insurance
ends, I'm going to have to cancel the rest of my treatment," said Kelly
Bachi, an Oklahoma boat repair business owner who has breast cancer and is
covered through a pool.
Cancer treatment without insurance would cost her about $500,000, she
Bachi has not been able to enroll via the healthcare.gov federal website,
although not for lack of trying. She attempted to sign up half a dozen
times, was eventually able to create an account, but was later blocked
from accessing the account.
Others — including Jill Morin of Raleigh, N.C., who has a severe heart
condition and is covered by her state's pool — have not attempted to
"It's the unknown, the uncertainty that gets to me," Morin, 42, said. "I
don't know what my cost will be at the end of the day. I don't know if my
two cardiologists and my procedures are going to be covered under the
plan. There just isn't enough information on that website."
But, she said, she has no choice. She must pick a plan soon because she
can't afford to go without. She plans to go to an insurance broker for
advice, then contact the federal call center to bypass the online
State officials throughout the nation have been scrambling to figure out
how to help people like Bachi and Morin.
Last week, the board of the Oregon Medical Insurance Pool — which covers
about 11,000 people — ordered the state to create a contingency plan for
its members because the state's online exchange still has not enrolled a
For now, the only way to enroll for coverage in Oregon is to fill out a
19-page paper application. The state has so far received just 7,300 such
applications from all Oregonians, not just those in the pool, but it has
not yet processed any of them. The process takes up to several weeks, so
no one has completed it and successfully enrolled, Cover Oregon spokesman
Michael Cox said.
Oregon pool administrator Don Myron said he hopes to speed up enrollment
for its members by mailing them a paper application and following up to
make sure they filled it out.
In Indiana, the Department of Insurance extended the high-risk pool
coverage until at least Jan. 31 because of difficulties with the federal
health insurance exchange. Its pool covers about 6,800 people.
The move was crucial, officials said, because people in the pool were not
able to schedule treatments without proof of health coverage for the
coming year. Indiana will spend $6.3 million to extend the coverage.
In Wisconsin, the Health Insurance Risk-Sharing Plan that covers 24,500
people is rolling out an outreach effort to make sure their members are
signed up by the deadline, chief executive Amie Goldman said.
The state created a worksheet and directories of carriers to help people
prepare for enrollment, has sent postcard reminders and is answering
questions through its Facebook page and weekly newsletters.
Many of those in high-risk pools across the nation will be shopping for
insurance for the first time in years.
"Even if the technology was really perfect, it would still be hard to sign
up because many people who are really sick don't respond well to change,"
said Linda Nilsen Solares, executive director of Portland-based Project
Access NOW, which connects uninsured people with care. "Many of them are
just trying to get through the day."