McCain's Health Plan Focuses On High-Risk Pools John McCain's plan to insure more people would rely heavily on high-risk health insurance pools, where individuals with pre-existing conditions buy their own insurance. Critics argue that these pools are expensive and cover only a fraction of the uninsured and uninsurable.

McCain's Health Plan Focuses On High-Risk Pools

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The presidential candidates have not addressed it as much as some other issues but for voters health care remains key. This week, we continue our close look at the candidate's health plans. Today, NPR's Julie Rovner looks at one element of John McCain's plan that has raised questions about how sick people would get insurance.

JULIE ROVNER: If you get insurance through your job, it's illegal for insurers to discriminate based on your health but McCain's plan would encourage many more people to buy their own insurance in the individual market. A place where even John McCain probably couldn't buy coverage. That's because like millions of other Americans, he has a pre-existing condition. In McCain's case, he's a cancer survivor. But he says, he'll take care of that by giving people in less than perfect health a separate place to buy insurance.

Senator JOHN MCCAIN (Republican, Arizona, Presidential Candidate): Over 30 states have some form of high risk pool and over 20 states have plans that limit premiums charged to people suffering an illness and who have been denied insurance.

ROVNER: Those high risk pools are a key piece of the McCain health plan. He says he wants to sit down with the nation's governors to find ways to expand the existing pools and add programs to help people with chronic conditions take better care of themselves. There'd be more money too. McCain aides say as much as $15 to $20 billion in new subsidies. But Karen Pollitz of Georgetown University says there's a big problem with state high risk pools that goes beyond money.

Ms. KAREN POLLITZ (Georgetown University): The problem is when people get to these high-risk pools they usually can't get in.

ROVNER: Pollitz has been helping with the project ran by the American Cancer Society.

Ms. POLLITZ: They literally sent thousands of people who were uninsured, who needed to buy coverage, who had cancer to the high risk pools in their state. And more than 90 percent of the time people couldn't enroll.

ROVNER: That's what happened to the Meadows family. Debbie Meadows(ph) is 58, she gets disability insurance in Medicare. Her husband Gene(ph) is 61, he works as a service adviser for a car dealership outside Denver. His job offered health insurance but Debbie Meadows says, the couple decided they couldn't afford it.

Ms .DEBBIE MEADOWS: I think it was like $800 a month just to cover him.

ROVNER: So Gene decided to find his own, cheaper insurance. But when he went for the physical, the doctor discovered he had prostate cancer. That meant no private insurer would take him so the family turned to the state's high risk pool. It's going to cost a thousand dollars a month. But Meadows says the money hasn't even been the biggest obstacle.

Ms. MEADOWS: Well, they wanted public service bills from at least six months ago to prove that we've lived in Colorado. I mean, who saves their public service bill after they've paid it.

ROVNER: And Meadows says there were other paperwork requirements.

Ms. MEADOWS: And it's just been a lot of red tape and a lot of phone calls. And it's insane, it's insane.

ROVNER: There's another catch. Even if he gets into the pool, Gene Meadows will still have to wait six more months before it will cover his cancer. That's not unusual. Many high risk pools delay covering the condition that makes patient eligible in the first place. That's what happened to Barb Flemming(ph) in Missouri. She was diagnosed with breast cancer in January. Fleming had health insurance when she got the diagnosis but it was about to expire. The Missouri high-risk pool let her in, but told her she'd have to wait a full year for the coverage she needed most.

Ms. BARB FLEMING: I was approved for the pool as of March fourth which is the day I needed insurance but it would not cover my cancer. So I was going to be paying $908 a month for an insurance and I have been that was not covering the cancer.

ROVNER: Fleming was lucky she got her surgery before her old policy ended. She didn't need chemotherapy and after months of appeals, Missouri officials lifted the 12 month waiting period. Still she says, even though she's doing OK now, the fight took its toll.

Ms. FLEMING: You know, I hate to say this but I felt more in charge of my cancer than I ever felt about the insurance situation.

ROVNER: Still, Marynell Lenhard(ph) of the Blue Cross Blue Shield Association says there's a reason the high risk pools are so hard-nosed about who and what they cover.

Ms. MARYNELL LENHARD (Blue Cross Blue Shield Association): The idea is that you want to discourage people from waiting till the last minute, you know, the day they know they're going to the hospital for surgery and that's when they buy insurance. The idea of insurance is that you get people in early, they subsidize other people, then they get sick, they're subsidized by somebody else. But if everybody waits to the last minute, you don't have any subsidies, you just are paying out for expenses.

ROVNER: Lenhard says high-risk pools are needed to get the sicker people out of the regular individual insurance pool. Otherwise, they drive up everyone's premiums and that prevents the healthy young people from signing up. And those are the people insurance companies need most.

Ms. LENHARD: So, you want to make sure your coverage is affordable enough so that these very price (unintelligible) people in their 20s will buy coverage.

ROVNER: Lenhard and consumer advocate Karen Pollitz however, agreed that while in theory, the high risk pools being proposed by Senator McCain are a good idea, so far they've mostly been just too expensive. That's why only about 300,000 people total are enrolled in them out of 46 million uninsured. Julie Rovner, NPR News.

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