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Health Reform Brief: New High-Risk Pool for the Uninsurable

We at Champaign County Health Care Consumers (CCHCC) want to update you about a new provision of the national health reform law, The Patient Protection and Affordable Care Act (PPAC Act), that will soon be going into effect. If you are someone who might benefit from this new provision, I would like to hear from you as soon as possible.

Please read on for more information.

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HIGH-RISK POOL – INSURANCE FOR THE “UNINSURABLE”

The new PPAC Act provision about to go into effect is the creation of a temporary high-risk pool to provide health coverage to individuals with pre-existing medical conditions.

This is scheduled to be implemented around July 1, 2010. The PPAC Act specified that the high-risk pool is to be implemented within 90 days after the passage of the law.

The temporary high-risk pool will provide coverage until 2014 for many of those individuals who are currently uninsured as a result of pre-existing conditions (the “uninsurable”).

Starting in 2014, the PAAC Act prohibits health insurers from basing coverage or pricing decisions on health status and pre-existing conditions. Therefore, at that point in time, the high-risk pool will no longer be needed, and the people who are currently “uninsurable” because of “pre-existing” conditions, will be able to purchase health insurance just like everyone else.

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WHO IS ELIGIBLE FOR THE HIGH-RISK POOL?

The PPAC Act defines eligible individuals as:

1. Uninsured for 6 months
(if you are currently insured through the state’s existing high-risk pool — IL Comprehensive Health Insurance Program – ICHIP – you are not considered “uninsured”);

2. a citizen of the United States; and,

3. have a pre-existing condition.

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AFFORDABILITY OF NEW HIGH-RISK POOL:

The PPAC Act requires that the premiums paid by those covered by the temporary high-risk pool not be more than 100% of the standard premium rate. So, prospective enrollees should expect that the premiums will be as costly as current “standard” insurance rates. It is quite possible that low-income consumers may have a difficult time affording this high-risk insurance.

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HOW THE HIGH-RISK POOL WILL BE CREATED IN IL:

The federal government is making funding available to states in order for the states to implement their own high-risk pools, with guidance from the federal government.

The federal government has set aside $5 billion to support the establishment of these high-risk insurance pools in all states. Illinois is eligible to receive approximately $196 million of this funding.

The State of Illinois is pursuing the opportunity to cover more uninsured citizens in IL through the expansion of its existing high-risk insurance program, ICHIP (not to be confused with the children’s health insurance program, also called “CHIP”).

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IF YOU CURRENTLY HAVE INSURANCE THROUGH ICHIP:

Unfortunately, the federal funds cannot be used to reduce your premiums if you currently have health coverage through ICHIP. However, you should not experience any changes or problems with your current ICHIP coverage as a result of the PPAC Act.

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ARE YOU UNINSURED BECAUSE OF PRE-EXISTING CONDITIONS? I WOULD LIKE TO HEAR FROM YOU AS SOON AS POSSIBLE!

If you are currently uninsured because of pre-existing conditions and you think you might be eligible to get health coverage through the new high-risk pool, I would like to hear from you as soon as possible.

CCHCC is committed to tracking the development and implementation of the new IL high-risk insurance pool, and helping as many local consumers as possible qualify for this new health insurance coverage.

If you contact me or CCHCC about the new high-risk pool, we will keep you informed about any new developments and let you know when you can begin to apply for this health insurance coverage.

HOW TO CONTACT ME: You can write back by responding to this e-mail message, or you can write to me directly at my e-mail account at claudia@shout.net.

NOTE: Also, CCHCC has received requests from media who want to talk to individuals who may benefit from this new health insurance pool. If you are willing to share your story publicly by talking to a reporter, please let me know.

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THANK YOU, AND STAY TUNED!

As always, thank you for your support for CCHCC’s work. The PPAC Act is a large law that has many provisions that will be implemented over the next few months and years. CCHCC will monitor the implementation efforts and continue to keep you informed about new benefits as they roll out, and also about advocacy opportunities.

Best wishes,

Claudia Lennhoff, CCHCC Executive Director

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