THE UNINSURED: High-Risk Individuals Struggle to Find Coverage
In the third part of its series on California's uninsured residents, the Sacramento Bee examines those who are deemed at "too high risk" for coverage. Researchers estimate that up to two million Californians lack insurance because insurers deny coverage based on a "pre-existing medical condition" or offer coverage at a price beyond what people can afford. A pre-existing medical condition is "slippery," according to the Bee, as it can be broadly defined as "any medical condition, whether it requires treatment or not, that is known to the person when he or she applies for coverage." The "best way" for people with such conditions to get affordable health insurance is through an employer-sponsored plan, in which "insurers are now required to accept employee groups of two or more regardless of medical status." Medi-Cal does not exclude those with pre-existing conditions from coverage, but those who do not qualify for the program must turn to the Major Risk Medical Insurance Program, which "pools individuals who have been denied coverage and subsidizes a portion of their monthly premiums." However, MRMIP has a one-year waiting list and serves only about 20,000 people, "far fewer than are eligible and able to pay their share." Some experts believe that insurance companies overstate the risk of covering "high risk individuals." In MRMIP, for instance, 20% of enrollees each year do not make a claim, and since the program began in 1991, less than 15% of enrollees have had yearly medical costs of more than $5,000. However, Walter Zelman, president and CEO of the California Association of Health Plans, said that if insurers "accepted everyone, regardless of health status, they would have to spread the cost of caring for the sickest people around, leading to increased premiums for everyone" (Fisher, Sacramento Bee, 10/17).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.