Health Care

Georgia Won't Establish High-Risk Insurance Pools

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State officials in Georgia are not happy about the new federal health law. The governor has joined 19 other states that have filed suit to nullify it. And the state insurance commissioner is refusing to set up a high-risk pool to sell health insurance to people with medical problems.


In Georgia, state officials are not at all happy with a landmark new federal health law. The governor has joined 19 other states that have filed suit to get the law nullified, and the state insurance commissioner is refusing to set up a high-risk pool to sell health insurance to people with medical problems.

NPR's Joanne Silberner looks at how one state is dealing with this new law.

JOANNE SILBERNER: Julia Murphy at Atlanta used to be an executive assistant to CEOs - not anymore. Several years ago she got sick and had to give up her job. And now?

Ms. JULIA MURPHY: Well, I'm uninsurable. I've pretty much had continuous insurance all my life, but at present my diagnoses include multiple sclerosis, Addison's Disease, Hashimoto's Thyroiditis.

SILBERNER: And several other diseases. No insurance company will take her on. They know she'll cost them money. The new federal health law includes $5 billion from Washington to subsidize special health insurance like Murphy. The pools are to run until 2014 when insurers will have to drop their preexisting conditions limits. The pools will be run by states, or if states refuse, by the federal government.

About three dozen states already have their own high-risk pools; Georgia doesn't. Consumer advocate Linda Lowe(ph) says that's because of the attitude of local politicians.

Ms. LINDA LOWE (Consumer Advocate): There is a different view of government that it should be smaller and should not be engaged in these kinds of activities.

SILBERNER: The new federal law - passed with no Republican support - has been attacked by the Republican leadership in Georgia. Outgoing Governor Sonny Perdue is one of the governors suing to declare it unconstitutional. And state insurance Commissioner John Oxendine, who's in the Republican primary for governor, is refusing to establish the high-risk pools.

Mr. JOHN OXENDINE (Insurance Commissioner, Georgia): If the state creates a plan and administers a plan and we run out of money, people are going to be looking to us and our state treasury to pay for it. If we have to freeze it and say that we can't take anymore people because we got too many applicants, they're going to be looking at the state and saying, well, why are you doing this? Why didn't you plan ahead?

SILBERNER: Officials at the federal Department of Health and Human Services say they don't expect the money to run out - it's hard to know for sure. One federal actuary says it will, but Congress's own budget watchdog hasn't published an analysis yet.

MS patient Julia Murphy says even a couple of years would buy her time to figure something out. The irony is the states were given the option to set up their own federally subsidized plans as a way to permit more local control.

And in Georgia, a Republican state senator introduced a bill that would have established a high-risk poll during the last legislative session, though it did never come to a vote.

And Insurance Commissioner Oxendine has aimed his gubernatorial run at the more conservative part of the Republican Party. He says his opposition is very popular on the campaign trail.

Mr. OXENDINE: I think the average Georgian would say, I don't want to risk the state treasury and create another burden on the state.

SILBERNER: So, it's up to the federal government to set up the high-risk pool in Georgia. Again, consumer advocate, Linda Lowe.

Ms. LOWE: The fact that Georgia is not planning to do so may not be a problem for the individuals who would benefit from it.

SILBERNER: Because, she says, the federal government might be able to do it better than Georgia. Funding for the pools will be available July 1st.

Nineteen states, most of them led by Republican governors, have also opted out of running the pools themselves.

Joanne Silberner, NPR News, Atlanta.

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