Lawmakers have kept annual financing at or below $40 million a year, requiring the pool's administrators to cap its enrollment. As a result, for much of Schwarzenegger's tenure, the pool has had a waiting list of hundreds of people.
This year, Schwarzenegger and legislators provided a one-time allotment of $10 million out of fines against insurers to expand the pool's enrollment to 915 more people, including all those on the waiting list.
Even with that expansion, the pool will assist half the number enrolled at the program's apex in 1999.
One of the major obstacles is the cost of premiums, which the law sets at 125% of commercial insurance rates. More than a third of pool participants who dropped out this year told the pool's administrators that they couldn't afford it anymore. A 55-year-old Los Angeles County resident with one dependent would have to pay $11,240 in premiums and a $450 deductible this year for the cheapest plan.
Anne Walzer, a freelance graphic designer in San Francisco who is insured through the pool, said her premiums amount to 14% of her income. She said that she was diagnosed with the mildest form of multiple sclerosis.
Even though she has no symptoms and her doctor said the chance of serious sickness was minute, Blue Cross told her she was a "lifetime denial," she said.
"I'm healthy," said Walzer, 56, who said she pays $600 a month in premiums. "I hardly ever go to the doctor. I don't feel I belong in the major risk pool."
Despite its cost, California's high-risk pool is of limited use for people needing extensive medical care, such as those with cancer or chronic diseases. That is because the pool's benefits are capped at $75,000 a year, lower than the limits of any other state's pool.
Someone with hemophilia "would blow through that in a month and a half," said Doug Stratton, the outgoing chairman of the National Assn. of State Comprehensive Health Insurance Plans, an association of state high-risk pools.
Only five other states' high-risk pools have any annual benefit limits. Indeed, California's cap makes the state ineligible for between $4 million and $8 million in federal money to help finance the pool, according to a legislative estimate.
About 2.4 million Californians buy health insurance coverage directly rather than through employers. Insurers have broad discretion to reject applicants. About 20% of applicants are rejected because of their health history, said Peter Harbage, a healthcare consultant.
