N.C. insurance aims at high-risk cases

Health coverage is for those who are excluded from private market

By: JournalNow Staff | THE ASSOCIATED PRESS
Published: December 31, 2008

RALEIGH

A state-sponsored insurance pool that offers coverage to the riskiest patients has begun, but administrators are trying to draw more North Carolina residents who have been pushed out of the private market.

People can qualify if they don't have employer coverage and can't get private insurance without paying an exorbitant amount.

Since October, only about 500 residents have applied for the N.C. Health Insurance Risk Pool, with a couple hundred approved for coverage beginning Thursday.

But the program's executive director, Michael Keough, said that enrollments have been accelerating.

"These are tough times," Keough said. "People are out of work. People are doing what they can to survive. This is a particularly timely thing -- a godsend for people who need it."

Officials first projected that about 14,000 people would have the insurance 10 years from now and up to 4,000 people would join the first year. Keough said he thinks that up to 180,000 people in the state would be eligible.

It's a plan intended particularly for those with high-risk health conditions, such as multiple sclerosis or hemophilia.

But the insurance is still expensive.

Premiums are set at 150 percent to 200 percent of a healthy person's private insurance. The state subsidizes the program from a few sources, mostly a tax on health-insurance premiums and an annual cash withdrawal from the State Health Plan for public-service workers. It's starting operations with a $5 million grant from the Health and Wellness Trust Fund.

Christopher Estes, 54, of Pfafftown will pay about $615 a month to get coverage under the state's new plan. But that's much better than private insurance quotes that were twice as much, rising after his diagnosis with Parkinson's disease and a major seizure that exacerbated his condition.

He said that private premiums were stressing his home budget and put him within months of draining his savings. He and his wife were closely monitoring how they buy groceries and were saving on heating bills by wearing more clothes around the house.

"It's hard," Estes said. "My wife just did the budget for the month. We were short about $2,500. That's coming out of savings."

North Carolina legislators approved the health-insurance pool in 2007. It will cover only a small portion of the estimated 1.4 million people in North Carolina who are uninsured.