State guarantees care for critically ill

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More than 1,500 critically ill New Mexicans were guaranteed health coverage through the end of this year Friday when the New Mexico Medical Insurance Pool Board of Directors voted unanimously to underwrite costs for the small population of New Mexicans.

In taking that action, the medical insurance pool’s board accepted an offer of $12.2 million from Washington to cover medical claims for the population for the last six months of this year even though it is millions of dollars less than what the state medical insurance pool has estimated medical care will cost for the individuals. Last year, 39 individuals in the federal high-risk pool alone generated $7.5 million in claims, the medical insurance pool’s executive director, Reena Szczepansski, said this week.

“We were troubled by the anticipated catastrophic disruption in our enrollees’ continuity of care,”

John Franchini, New Mexico’s Superintendent of Insurance and chairman of the medical insurance pool, was quoted as saying in a news release issued Friday.

In accepting Washington’s offer, the New Mexico Medical Insurance Pool, which currently administers the program for the federal government, accepted the possibility that medical claims could eclipse $12.2 million before the end of the year and that it would assume the liability.

Federal officials declined to comment on the situation in New Mexico this week.

Had no deal occurred, the federal government would have transferred the sick New Mexicans into a different program starting July 1 that state officials said could have pushed health coverage out of reach for many.

More than half of the 1,568 individuals potentially affected live at or below twice the federal poverty level — $22,344 for an individual and $46,104 for a family of four. The new program would have required $1,250 deductibles, more than twice what they pay now, Szczepansski said. The individuals also would have paid larger out-of-pockets costs to trigger health coverage and could have faced uncertainty over whether their current doctors and specialists will treat them.

Now, “there will be no disruption in care for the beneficiaries,” Szczepansski said in a phone call Friday afternoon.

The dispute between the Medical Insurance Pool and the federal government began earlier this year when Washington started trimming money earmarked for federal high-risk pools started in 2010. The pools were started to help critically ill individuals across the nation who couldn’t qualify health coverage in commercial insurance markets, mostly because of pre-existing conditions.

The medical insurance pool will investigate ways to cut costs but there is no talk as of yet about changing benefits individuals receive or changing the amount they pay in monthly premiums, Szczepansski said.

New Mexico’s health insurance carriers currently pay most of the medical insurance pool’s operating costs through assessments. With the board’s decision Friday, the insurers in effect were guaranteeing that they would pick up the costs, an action that won plaudits from the board’s vice chairman.

“New Mexico’s insurers have stepped up in light of the federal government’s abandonment of this program,” Jason Sandel said in the news release.

Even so, medical insurance pool board members hope Washington will honor its commitments to pay for all the beneficiaries’ health coverage through this year. The critically ill population would be covered starting Jan. 1 under the federal health care law.

Gabriel Parra, a board member representing Presbyterian Health Plan, urged federal lawmakers “to find a way to meet commitments that were made” in 2010 in Friday’s news release.

The medical insurance pool also administers a separate program that covers 8,500 critically ill New Mexicans who were never in danger of being affected by the dispute.

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