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Accountable Care in Action

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Health Care Reform

Friday, August 06, 2010

MRMIB Unveils Rates, Details on New High-Risk Insurance Pool

On Thursday, the Managed Risk Medical Insurance Board announced premium rates and said it has selected two companies to help administer California's new high-risk health insurance pool, the San Francisco Chronicle reports.

The federally supported pool -- called the Pre-existing Condition Insurance Plan -- is the first major initiative from the federal health reform law to take effect in California. To be eligible for the new pool, residents must be legal residents, uninsured for six months prior to applying and have a pre-existing health condition.

California still must finalize its contract with the federal government before it can receive $761 million to run the program.

Premium Rates Set

MRMIB set an array of premium rates that vary based on county and age. In the San Francisco Bay Area, rates will range from $140 monthly for people ages 15 and younger to $1,003 monthly for residents older than age 74 (Colliver, San Francisco Chronicle, 8/6).

In San Diego, premiums will range from $127 monthly for those younger than age 15 to $904 monthly for those older than age 74.

Administrators Selected

MRMIB tapped the Virginia-based firm Maximus to manage enrollment for the high-risk pool and selected the Pennsylvania-based company HealthNow Administrative Services to oversee contracts with medical service providers.

Applicants Lining Up

Residents can file applications this month to begin receiving coverage through the pool in September (Lavelle, San Diego Union-Tribune, 8/5).

As of Thursday, almost 4,000 state residents had requested applications, according to the Chronicle.

The state estimates that the new pool will be able to cover up to 25,000 residents. California's existing high-risk pool -- which will continue to operate alongside the federally supported pool -- has the capacity to cover about 7,100 residents (San Francisco Chronicle, 8/6).

Reader Comments:
  • 4
  • 08/09/2010
  • James Roache

I don't believe Dr. Rob and I fundamentaily disagree at all on the definition of insurance. However, I draw the line whenever someone feels a private sector company such as Anthem, should be subsidized by the "People through taxation" if they fail to be actuarily sound. Business is business, this is not socialism. If they fail as astute businessmen, Wall Street will vote and "Redistribution" of their tyranical executives wealth will certainly be occur. I agree the people should and will vote with their feet and dump Anthem or the Legislature will certainly call them on the carpet as was done with their recent 30% rate increase sham. (BTW, its now down to 20%. You may wish to ask yourself why a 33% decrease all of a sudden...hmmmm?) Dr. Jim

  • 3
  • 08/09/2010
  • Robert Forster

My definition of "insurance" and the business model differs from Mr. Roache's concept. Insurance is a business model that provides mitigation of risk and provides security for a population of people who contribute to the cost by risk level or a group average. The crux of insurance is that some will use resources less than their contribution to the cost (premium) and others will use more. However, to work, the total population must use resources slightly less than than the total cost. In a pure context, it is a redistribution of wealth for peace of mind to protect all from catestrophic costly events. It either must be acturarily sound or if not, subsidized by the People via taxation.
Additionally if any health care company charges (premiums)beyond the market for comparable products, the consumer should and will walk with their feet--Americans do not lack competitive choices but envy what we call fiscal success-i.e. achievers (employers). Rob MD

  • 2
  • 08/06/2010
  • Hatti Hamlin

While this program clearly addresses those people who cannot get individual insurance now at any price, it's hard to imagine how it really addresses the issue of affordability. It's hard to imagine what segment of the population is going to find $1000 a month "affordable." Is this really an answer to the problem?

  • 1
  • 08/06/2010
  • James Roache

I find it intersting that Anthem, in particular, shows "little interest" (7/27/10) in the servicing the high risk insurance pools in California. Exactly what is "insurance"? It is a group of individuals (beneficiaries) who pool assets (premiums) to protect ALL individuals of the group from more costs for care than they could pay as an individual. Simple isn't it?
That is, until you bring in someone like Anthem, that has record breaking profits, $billions of assets (paid for by our premiums), exhorbetent executive salaries and bonuses and freedom to raise their rates at will. Yet now we have to create a $791 million federal agency because they don't want to keep or insure the high risk patients. Here's another thought, how much will their premiums go down next year as we taxpayers create pools to take on their responsibilities and further increase their profits? The high risk population of 25,000 is 7/100ths of 1% % of CA's population. For shame Anthem, your greed repulses me !!!



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