Uninsured Have Limited Options Until 2014

Many uninsured people will be able to get coverage under the federal health law. Those changes, however, don't kick in until 2014. Until then, they can try to get insurance on their own, which is expensive. Or, they can apply to join high-risk pools.

STEVE INSKEEP, host:

Let's talk about this some more with NPR health policy correspondent Julie Rovner, who's in our studios.

Julie, good morning.

JULIE ROVNER: Good morning.

INSKEEP: Just to clarify what's happening here, isn't the health care law that Congress passed last year supposed to cover or at least give people an opportunity - everybody an opportunity to get covered in a situation like this?

ROVNER: Well, yes. And assuming it doesn't get repealed or ruled unconstitutional, it will. And it will help couples like these. But, as Jenny pointed out in her story, that won't happen until the year 2014. And between now and then there's a lot of frustration and consternation on the part of patients and, I might add, states.

INSKEEP: What are the options for people in a situation like the Boyles, because there must be many?

ROVNER: Well, yes. There is a new program that's already in effect called a high-risk pool that was established into law and it's supposed to give the uninsured a way to get insurance between now and then, sort of a bridge to coverage, if you will.

INSKEEP: High-risk pool, that just means you're at high-risk for disease. Insurers are not really very interested in giving you anything very affordable and so you're thrown into this pool people where you're supposed to be able to get insurance.

ROVNER: Exactly. Now technically, this couple could get into one of these pools, which are available in every state. But there are some big catches that have kept a lot of people from signing up.

INSKEEP: Catches?

ROVNER: Catches. Yes. One big one is that in order to get into those pools you have to have been uninsured for at least six months. That means in cases like the Boyles, where they're losing insurance at the end of the month, they'd have to wait until September before they could sign up for the program.

INSKEEP: Okay.

ROVNER: Another big obstacle in the high-risk pools is price. I did a little research. In Pennsylvania, it would cost each of the Boyles $283.20 a month or $600 for the two of them. That's a lot less than the high-risk pools that a lot of states run on their own. But it's still a whole lot more than the $36 a month that they've been paying under the plan that's ending.

INSKEEP: Oh, okay. So the question is if you got the $600 a month or almost $600, you can benefit but if not, you're out of luck? So how many people are signing up for the new high-risk pools under the new health care law, the National Health Care Law?

ROVNER: Well, a whole lot fewer than have been expected. Nationally, as of February 10th, there were just over 10,000 people enrolled in the plans. Now that's a 50 percent more than there were back in November. But it's way below the estimates that were between 200,000 and 375,000 people that were expected to enroll in the first year.

In fact, more than a few governors declined to set up their own high-risk pool programs and they let the federal government step in and do it. They were afraid that the program would be overrun with people and become too expensive.

INSKEEP: All right. Well, why has it been a flop instead?

ROVNER: Well, if you ask federal officials, of course, they say it is not a flop. They point out it's still very new, that programs like the Children's Health Insurance Program, which now covers more than nine million low and moderate income children, also got off to a relatively slow start. But there's other reasons that this particular program hasn't been all that popular. A couple we've already mentioned, the six-month waiting period and that it's expensive, but there's also the problem that a lot of people who could be enrolling in this plan just don't know that it's out there.

We keep talking so much about how this new coverage isn't going to start until 2014, people have no idea that some of its already begun.

INSKEEP: Okay, so let's get back to the Boyles, this couple that we've profiled. They've got a problem, they've got a problem now. What options do they have?

ROVNER: Well, for actual health insurance between now and 2014, there are not that many options unless, obviously, one of them finds a job that offers employee health insurance. In the meantime, they can probably get primary care from a community health center. There's more than 1,200 health centers that serve more than 20 million people every year, most of them low income or uninsured.

INSKEEP: Just to be clear, there's a lot of states where there are cutbacks in health coverage that people have today or have had up until today. You say there are some other options? But aren't there efforts in Congress to cut back on the options?

ROVNER: Yes, there are. The budget bill that's moving through Congress right now would cut funding by more than a billion dollars and it might make that kind of service a lot harder to come by.

INSKEEP: How are the problems in various states going to affect the national debate then, over health care?

ROVNER: Well, nearly every state is struggling with budget shortfalls. Health costs are a huge part of every state's health problem. The nation's governors are coming to Washington later this month and they are going to be talking about what they want to do about the Medicaid program, a huge, huge budget issue, and what they're going to do about health costs. It's a really big issue. So there's a lot more to come on this subject.

INSKEEP: Julie, it's always a pleasure to talk with you.

ROVNER: Thank you, Steve.

INSKEEP: That's NPR health policy correspondent Julie Rovner.

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