WASHINGTON – Tina Cartwright suffers from reflux-esophagitis, better known as acid reflux, but she said the pain in her stomach is coming from a health insurance industry that refuses to cover her disease.
“I’m angry at the way the whole health insurance thing is run, it’s ridiculous,” said Cartwright, 28. “I feel like they’re acting like I have all of these medical conditions and I just have the stomach condition.”
The Timonium resident is like thousands of Marylanders who have a pre- existing medical condition that limits their health insurance coverage or denies them coverage completely.
Maryland’s newest insurance plan, set to begin this summer, is aimed at helping people like Cartwright. The Maryland Health Insurance Plan will charge a little more to provide coverage to those people who cannot get it elsewhere.
Enrollment for the plan begins in July, said Richard Popper the executive director of the Maryland Health Insurance Plan. He said premiums will probably range from $250 to $350 a month, and deductibles under the plan’s preferred provider option will probably range from $500 to $1,000.
Popper said the plan will be available to individuals who make up to about $105,000 a year.
But critics are already complaining that the plan will cover only a fraction of the 650,000 people without health insurance in Maryland, and that its cost will put it out of reach of all but a few well-off patients.
“I think this program is a lot of political posturing,” said William Simmons, the president of Group Benefit Services Inc., which specializes in administering insurance plans. “I don’t think it’s going to have a lot of impact on anything. . . . I doubt it very seriously.”
Simmons said the new plan will not benefit those individuals who really need the coverage: Those people who make too much to qualify for Medicaid, but far too little to afford the premiums and deductibles expected in the state plan.
“If you make minimum wage you’re barely above the poverty level, you’ve got other things to worry about besides health insurance, like food and housing,” Simmons said.
But Popper said the plan was never meant to be a cure-all for the state’s uninsured. He estimated that about 10 percent of the state’s 650,000 uninsured have a pre-existing condition that makes them uninsurable — far more than the 15,000 the plan can cover.
“High-risk pools are not designed to provide coverage for everyone,” he said. “You have to realize that people enrolled in the program are going to be paying about 150 percent of what people without a pre-existing condition pay.”
The extra cost will be worth it for Sharon Krickler, who is happy that she will be able to get health insurance at all. Krickler, a diabetic amputee, said she has been turned down repeatedly for insurance, even though she has been willing to pay a $2,500 deductible.
“People with diabetes and heart conditions are being turned down all the time,” she said. “I figured that if I chose a higher deductible I might be more appealing to them (insurance companies).”
Krickler, 56, said that when she had her foot amputated last year, her biggest worry was not the loss of the foot, but how she was going to pay for it. The new plan is perfect for her because she does not mind paying a little more to get covered.
Enrollees in the new plan will have benefits that are nearly identical to those offered under Maryland’s small-group insurance package. They will include services like family planning, chiropractic services, hospice care and no cap on prescription drugs, Popper said.
The new plan, created under the Health Insurance Safety Net Act in 2002, will replace the state’s Substantial Available Affordable Coverage program. Under that plan, participating insurance companies got a break on a hospital surcharge that was worth about $50 million in 2001, money the companies used to offset the costs of the program.
But state legislators felt the old plan paid too much to insurance companies, while the companies felt the small number of providers meant too much risk.
The state will use the $50 million that had been going to SAAC discounts to fund the new program, along with about $1 million in federal fund and premiums paid by the insured, Popper said.
Unlike the old plan, which accepted new clients only during a two-month open enrollment period, enrollment in the new plan will be available year-round.
The new plan lists about 40 pre-existing conditions — like Type I diabetes, AIDS, leukemia and sickle-cell disease — that qualify people for coverage. It will also be available for people who can show that they would have to pay a premium higher than the state plan’s rate.
The state will be subsidize about half of the monthly premiums of individuals under the new plan, Popper said. But premiums will still be slightly higher than SAAC premiums for some individuals.
While the new plan will be able to handle 15,000 clients, Popper expects initial enrollment of about 11,000. He said 7,000 to 8,000 SAAC enrollees will automatically roll over to the new plan, with more joining after it debuts in July.