Advertisement

California adds patients to health insurance rolls

More than 6,000 with preexisting conditions are getting coverage for medical care under a temporary program.

January 03, 2012|By Anna Gorman, Los Angeles Times
  • Architect Richard Best said he finally qualified for coverage after insurers had denied claims because of back and knee surgeries and moderately high blood pressure. Since getting onto the states plan, he has undergone sinus surgery and been treated for cataracts.
Architect Richard Best said he finally qualified for coverage after insurers… (Anne Cusack, Los Angeles…)

Despite a slow start, California's push to extend health coverage to those with preexisting medical conditions — a three-year stopgap effort until federal healthcare reform fully kicks in — has enrolled more than 6,000 patients.

California now ranks second only to Pennsylvania with the highest number of enrollees in the temporary federally funded insurance plan. The interim coverage helps people with cancer, heart disease and other long-term disorders pay for doctor visits, hospital stays and medications.

"It was really a lifesaver," said Catalina Island resident Doug Lord, 64, who has kidney disease and prostate cancer. "No one would insure me."

Lord, a boat captain and former Avalon city councilman, said he didn't seek cancer treatment after being diagnosed because he was uninsured and couldn't afford it. "Feeling like I had nowhere to go and had no one to take care of me was pretty stressful," he said.

California was the last state to offer the coverage. But the number of applicants jumped after an aggressive marketing campaign and a drop in premiums. Now, with a higher-than-expected influx of federal dollars for 2012, the state plans to continue publicizing the plan. To be eligible, applicants must be U.S. citizens who have been uninsured for six months and have been denied coverage because of a preexisting condition.

"We are going full speed until the federal government tells us to stop," said Janette Casillas, executive director of California's Managed Risk Medical Insurance Board.

The program is scheduled to end in January 2014, when insurers will be required to accept patients with previous illnesses without charging them higher rates.

Extending coverage to people with preexisting conditions has not generated the controversy surrounding other parts of the healthcare overhaul, including the requirement that every American get health insurance or pay a fine. Officials fear that if the universal coverage mandate is overturned in court, healthy people may not seek coverage, leaving insurance companies with the most expensive patients, including those with preexisting conditions.

That could present major financial challenges to long-term healthcare reform, officials say. "It is definitely a huge concern," Casillas said.

The insurance plans for those with preexisting medical problems can be seen as either "a bridge or a Band-Aid to get to the real reform," said Anthony Wright, executive director of the California consumer group Health Access.

"The big goal is changing the way insurers do business so they can no longer compete by avoiding sick people," he said. "That said, it is a huge lifeline for those who have it."

About five years ago, 39-year-old Gabe Chavez lost his job — and his insurance — when the automotive parts store where he worked was sold. He found work elsewhere, but the company didn't offer insurance. He tried to buy individual health coverage but was denied by several companies because he has diabetes.

"As fast as I put the application in, they turned me down," said Chavez, who lives in Alameda. While uninsured, he avoided going to the doctor. "It was scary. Diabetes is something you have to constantly watch."

The state's insurance plan gives him peace of mind, he said.

Insurers also denied coverage to Beth Levendoski, 57, because she has a hereditary neurological disorder that has led to problems with her spine. For about 10 years, she has paid for doctor's visits in cash. When she started to get partial paralysis in her legs last year, she had to scrape together more than $70,000 to pay for a surgery.

Levendoski, who was executive director of a nonprofit until last year, said she followed the federal healthcare law in the news and applied for the pre-existing condition plan as soon as it became available. Since getting coverage, she has had two more surgeries and seen improvement in her legs.

The only downside, she said, is the cost. In California, the monthly premiums for preexisting condition coverage range from $119 to $535, in addition to co-pays and deductibles. Premiums were cut last year but are still out of reach for some.

California was allotted $761 million in federal funding for the program and is scheduled to receive $347 of that through 2012.

State officials initially planned to sign up about 23,000 people for the program, but soon realized how sick enrollees were. "The individuals who are coming into the program have more pent-up demand for medical services than what we had budgeted," Casillas said.

Richard Best, an architect, said he was relieved to qualify. Insurers had been "unanimous in their rejections," denying him because he had back and knee surgeries and moderately high blood pressure. Since getting onto the state's plan, Best has undergone sinus surgery and been treated for cataracts.

"Preexisting conditions shouldn't be a curse," said Best, 54. "Human nature is that we get worse over time."

anna.gorman@latimes.com

Advertisement
Los Angeles Times Articles
|
|
|