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Insurance bridge coming

Washington state setting up high-risk pool built on federal funds

Washington is set to start a new federally funded high-risk health insurance program.

It is designed to cover people who are unable to obtain insurance, such as former and current cancer patients.

The state’s program will serve as a 3 ½-year coverage bridge until federal health insurance reforms passed this spring take hold Jan. 1, 2014.

While Washington opted to set up its own state high-risk pool, other states – including Idaho – have rejected the idea of doing so. The federal government earmarked $5 billion in the recently passed health care legislation to create state-based, high-risk pools as a way to help sick, uninsured Americans between now and 2014.

In states that choose not to participate, the federal government will operate high-risk pools and expects to be able to fund all the programs without putting new burdens on states.

Stephanie Marquis, a spokeswoman for the Washington state Office of the Insurance Commissioner, said Friday that no state funds will be used to operate the high-risk pool in Washington. Instead, the state expects $102 million from the federal government to fund the insurance coverage.

Residents enrolling in the high-risk program will pay premiums, although those amounts have yet to be determined.

“We’re talking about people who have tried to buy coverage in the private market … but were screened out because of a pre-existing condition,” Marquis said.

According to the legislation, individuals who sign up for the new pools will not have to pay more than $5,950 a year out of their pockets for medical care.

Insurance regulators are unsure how many people may qualify. As of Friday there were about 843,700 uninsured Washington residents, including nearly 78,000 children.

Current high-risk pools in 34 states cover only about 200,000 people. Many high-risk pools charge such high premiums that many people cannot afford coverage.

State officials said the Washington high-risk pool will begin July 1.

To be eligible, a person must be a U.S. citizen or reside legally in the country; have been uninsured for six months; and have a pre-existing condition.

The state will manage the program, encouraged by its experience with the Washington State Health Insurance Program.

That state program was created 23 years ago and is managed by a private, nonprofit organization. It was established to provide coverage for the highest-risk residents. There are 3,578 people enrolled in WSHIP, which is funded through patient premiums and a fee charged to health insurers doing business in the state.

WSHIP will cease in 2014 when the federal reforms take hold and outlaw coverage denials for people with pre-existing conditions.

Information from the Associated Press was used in this report.


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