Insuring Your Health

Many In High Risk Pools Aren’t Protected From Lifetime Coverage Limits

By Michelle Andrews

January 31st, 2012, 2:40 PM

Thanks to the health care overhaul, most people no longer have to worry about getting sick and running out of health insurance coverage. The law eliminated lifetime limits, which ran in many plans from $1 million to $2 million. Unfortunately, though, the change doesn’t apply to plans that enroll some of the sickest people: those who buy coverage in so-called high-risk insurance pools because they have medical problems that make them uninsurable in the private market.

People in the pools are left out because of a wrinkle in legal language. The law applies to health plans and health insurance issuers as defined by the Public Health Service Act, “but most of the risk pools aren’t licensed as an insurance issuer in their state, so from a regulatory standpoint we’re not equivalent to a commercial insurance product,” says Amie Goldman, chair of the National Association of State Comprehensive Health Insurance Plans, an educational organization for the high-risk pools.

Those affected include some of the 45,000 people who have enrolled in the new pre-existing condition insurance plans (PCIPs) established under the overhaul law and the more than 220,000 who are in the generally pricier, old high-risk pools who can’t join the new PCIPs because in order to qualify people have to be uninsured for six months.  It could be worse. Even though not required by law to eliminate such lifetime limits, some of the plans have opted against the caps anyway. That includes the PICPs run by the federal government in 23 states and the District of Columbia. (The other 27 states run their own PCIPs.)

And in some states, officials have moved to lift limits on occasion. That’s what happened in Kansas last year, where officials raised the lifetime limit in the state high-risk pool from $1 million to $3 million. Why? “We had people bumping up against the limit,” says Sandy Praeger, the state’s insurance commissioner.

5 Responses to “Many In High Risk Pools Aren’t Protected From Lifetime Coverage Limits”

  1. Rich says:

    Again, more outrageous BS about private Health care insurance companies! Are you covered? Aren’t you covered? How much coverage do I have? Will my coverage be enough if I get sick? Can my insurance policy be canceled is I get cancer? WTF! There should be absolutely no question in anyone’s mind that the main problem with our health care system is the existence of private health care insurance companies and the lobby groups on K Street that buy members of Congress to vote for pro-insurance legislation. Isn’t it time we ended the insanity and try something different. Anything is better than what we have today! Private insurers have had their way for many decades and they have screwed up our health care system to a state beyond repair. It’s a complete mess and insurers like that mess because they continue to profit by raping and abusing the consumer! It’s time we eliminated health care insurance from the health care equation! It’s time we sent them packing and enacted a single-payer health care system for every American. What do we have to lose? It can’t get much worse than it is today!

  2. Bill G says:

    What do we have to lose?

    1. Quality healthcare.
    2. Timely healthcare.
    3. Astronomical taxes.
    4. Huge government bureacracy.
    5. Single-payer health care has not been proven sucessful anywhere.
    6. Profit margins at “greedy” insurance companies are close almost always 5% or less!
    7. The rise of health insurance companies in this country GREATLY expanded access to healthcare for Americans. Read your history. Before health insurance, most people avoided seeking medical attention because of the related costs.
    8. Health insurance companies continue to put pricing pressures on MEDICAL PROVIDERS…which is where the real expense situation lies. Insurance companies spread the risk of healthcare and make it more affordable.

  3. Longfisher says:

    Medicare is a highly popular single payer health care program that is without any doubt successful.

  4. Rich says:

    Hey Longfisher; Without any doubt, Medicare is the model for the world in single-payer health care systems. What is driving our economy broke isn’t a broken Medicare or Medicaid, it’s the greed that Bill G. defends to the very end. My guess, he’s a Repiglican. Greedy doctors, greedy hospitals, greedy drug companies, greedy insurance companies all collude together to drive up costs and rob health care consumers blind. Maybe if Bush/Cheney had a plan to pay for the Iraq war and the Afghan war and the 2001 tax cuts for the wealthy and the 2003 tax cuts for the wealthy, all unfunded measures, maybe we would not be so broke. Those four unfunded George W. Bush measures added $4T to the public debt alone. By the way, along with Medicare, don’t forget the successful single-payer VA health care system and the successful single-payer TriCare health care system. Repiglicans are still trying to figure out how to privatize those successful programs so they can ruin them just like they ruin everything else they get their greedy little hands on. It’s nothing but rotten GOP members of Congress that support a rotten health care system run by corporate Wall Street thieves!

  5. LEWMD says:

    None of the programs above are successful standing alone since they depend on cost shifting and unreported costs throughout governement. I am an independent, but what is a repiglican? It sounds as if someone can not spell or perhaps is just rude.