Texas Health
8:08 am
Tue November 19, 2013

Dewhurst wants closure of high-risk insurance pool postponed

Amid ongoing technical issues with the federal health insurance marketplace created under the Affordable Care Act, Lt. Gov. David Dewhurst is urging state officials to postpone the planned Jan. 1 cancellation of the state’s high-risk insurance pool, which provides health coverage to some of the state’s sickest residents.  

“It is clear that the Obama Administration’s attempts to implement the deeply flawed Affordable Care Act are an abject failure,” Dewhurst said in a Monday letter to Julia Rathgeber, commissioner of the Texas Department of Insurance. “Far too many people with significant health care needs have been left unable to make rational decisions about their options due to the confusing, incomplete information being provided by the Obama Administration.”  

President Obama’s signature health reform law requires most Texans to carry health insurance by March 31, 2014, but technical difficulties with the federal website, healthcare.gov, have blocked many people from applying for tax subsidies and finding new coverage on the federal health insurance marketplace set up under the new law. Fewer than 3,000 Texans successfully found coverage on the federal health care marketplace during the first month of the six-month open enrollment period, which began Oct. 1, according to figures released by the U.S. Department of Health and Human Services. 

The high-risk pool, which currently covers 23,000 Texans, is financed mainly by patient premiums and assessments paid by health insurance companies and HMOs, along with some funding from federal grant programs. Since 1998, it has provided high-priced coverage to Texans with pre-existing conditions who can’t find coverage elsewhere. The state has deemed the high-risk pool obsolete, as the Affordable Care Act prohibits insurance companies participating in the federal marketplace from denying coverage to Texans with pre-existing conditions. Gov. Rick Perry signed Senate Bill 1367 in June, scheduling the pool’s abolishment. 

Meanwhile, thousands of Texans have also had their current health insurance coverage canceled because it does not meet regulatory requirements in the ACA. Although Obama has pushed to change federal rules to allow insurance carriers to renew customers' existing policies, even if they don't meet the new regulations, many fear it may be too late to keep Texans from losing health coverage.  

To have coverage on Jan. 1 through the federal marketplace, Texans must purchase the health plan by Dec. 15. High-risk pool enrollees with pre-existing conditions are particularly vulnerable, health care advocates warn, because a lapse in coverage could delay necessary medical care or result in extremely high costs.  

"We know of some that have completed enrollment in a new plan, though we can’t be sure how many," Steve Browning, executive director of the high-risk insurance pool, called the Texas Health Insurance Pool, said in an email. Many high-risk pool policyholders are not eligible for federal premium assistance in the federal marketplace, he added, because their household income is either too high or too low. "We’re trying to get the message out that if they know they are not subsidy-eligible, they should go ahead and purchase new coverage directly from an insurance company" without going through the federal website, he said.  

John Greeley, a spokesman for TDI, said in an email to the Tribune that the department has been monitoring the closure of the high-risk pool and has had conversations with state leadership on extending coverage for existing enrollees. "We are currently working through the mechanics of how an extension of coverage might be accomplished," he said. 

Secretary of Health and Human Services Kathleen Sebelius has said she believes issues with healthcare.gov will be fixed by the end of the month, but some officials are doubtful.  

Dewhurst added in the letter that he would offer the full power of his office to assist in delaying the scheduled termination.  

This article originally appeared in The Texas Tribune at http://www.texastribune.org/2013/11/18/dewhurst-calls-postpone-high-risk-insurance-pool-c/.