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High Risk Pool Good News for 'Pre-Existers'

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(Sacramento, CA)
Monday, June 28, 2010
It can be tough for Californians with pre-existing conditions to get health insurance. As Anthony Wright puts it,“They can’t get coverage at any price.”

Wright heads the advocacy group Health Access. He estimates up to 400,000 Californians are without coverage because of pre-existing conditions.

“We’ve seen people with heart burn or toe fungus, or everything in between, be denied coverage,” says Wright. “The passage of this bill means for tens of thousands of people help is on the way.”

What the bill does is put some 30,000 Californians with pre-existing medical conditions are a step closer to obtaining health insurance. The state legislature approved the new 760,000,000 dollar fund in order to bring Californian law into compliance with the new health care legislation passed earlier this year by the Congress. All the money in the fund comes from the federal government.

For individuals on this plan, the U.S. government picks up 65% of the costs, with the patient picking up the rest of the tab. Meanwhile, California operates a high risk pool. In that plan, the state pays only 40 % of the costs.  The state also caps care costs at 75,000 dollars per year, or 750,000 dollars per lifetime. The federal plan has no payment cap.

Governor Arnold Schwarzenegger will sign the bill. After that, there’s a few formalities to be worked out with the federal government before the program can be implemented. Managed Risk Medical Insurance Board spokeswoman Jeanie Esajian says the program should be started by the end of the summer.

“Our goal is to open up applications in August, with coverage beginning in September,” Esajian says. “We know there’s a great need out there, and we’re doing our best to roll this program out as quickly as possible.”

As for the 7,100 Californians on the state plan-they won’t be able In order to qualify for this new federal coverage. Applicants need to have lacked insurance coverage for 6 months, and have a pre-existing condition.  The insurance pool acts as a bridge between now and 2014, when Federal law will extend coverage to all Americans.  
California’s passage also helps give some cover to the Obama administration. Recently, U.S. GOP Senators have criticized the administration for taking too long to administer the federal program. California’s passage means the state will be ready to receive its share of the funds---about 15% of the total 5 billion dollar federal allocation---on July 1st.
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