SOURCE: Foundation for Health Coverage Education

September 10, 2008 15:44 ET

U.S. Uninsured Helpline Founder Sees Need to Update States' Medical High Risk Pools

"While our poorest citizens are guaranteed health coverage through state and federal programs ... the uninsured middle class (who qualify) for state high risk pools find only long waiting lists and out of date coverage limits..."

SAN JOSE, CA--(Marketwire - September 10, 2008) - With a tripling of calls and visits to its live help line and website mirroring the country's unemployment/layoff surge in the past six months, Foundation for Health Coverage Education (FHCE) founder Phil Lebherz is concerned about the limited coverage most state high risk pools offer to those with pre-existing conditions.

"The good news is that an increasing number of the nearly one-third of the 45.7 million uninsured in America who were eligible but unaware of government programs are now signing up and getting coverage," said Lebherz. "However, the bad news is that while our poorest citizens are guaranteed health care through state and federal programs, the uninsured middle class with pre-existing medical conditions find only long waiting lists and out of date coverage limits through the various state high risk pools. These people have pre-existing conditions that disqualify them from typical individual coverage. The high risk pools were designed to protect members of the middle class who can't find individual health insurance due to pre- existing conditions. However, in many cases, risk programs can't accept everyone who applies," said Lebherz.

Enquiries to the FHCE U.S. Uninsured Help Line and coverageforall.org website have tripled compared to enquiries last year. The coverageforall.org website alone has averaged over 28,000 unique visitors a month in the most recent quarter.

The rise in unemployment during this time period is up from 4.9% in January to 5.7% in July. And as people turn more and more to individual coverage, those who have pre-existing medical conditions in many states apply to their state's high risk pool.

"There are a number of challenges associated with these state risk programs today," says Lebherz. "Often there are wait lists which result in the use of emergency rooms for the first dollar of care, which is wasteful to the system. Another issue is that there are often unnecessary constraints placed on the programs whereby the plan cannot offer benefit options the rest of us have, such as varying deductibles. Also, many plan structures are outdated. In California, for example, in the Major Risk Medical Insurance Program (MRMIP) there is an annual cap of $75,000 and a lifetime cap of $750,000 for treatment of the recipient's pre-existing condition. This contrasts with an average lifetime cap of $5 million offered by most private insurance programs. This low figure shows how far behind the market this state's risk pool program has fallen which makes its policies more expensive and less effective."

Lebherz urges that state health care policy experts review their state's programs to identify possible shortfalls. "We hear these issues raised in calls to our help line daily and they need to be addressed."

The FHCE has captured, on a single website database, more than 144 government-sponsored programs to help people in need of health coverage. To identify what they qualify for, website visitors can first take the simple 5-Question Eligibility Quiz online, or they can phone the free 24/7, multilingual U.S. Uninsured Help Line at 800-234-1317 and talk with a live counselor who will review the questions with them. This eligibility review is a starting point with the Fresno, California-based call center's staff who will then guide each caller through their options and to the appropriate state-sponsored program.

As of August 2008, the U.S. Uninsured Help Line and website have guided more than 372,516 people through their health insurance options since its inception in 2005.

The Foundation for Health Coverage Education is a non-profit 501 (c) 3 public organization based in San Jose, California. For more information, please visit the website at www.coverageforall.org.

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