Unintended Consequences (Again)

Just wanted to drop in and post a quick note about some of the things we are seeing in the marketplace. We had an interesting case last week where we had a family apply for family coverage and receive some unexpected news. We ran into another example of the unintended consequences of the Patient Protection and Affordability Act.

The family we've been working with had 4 members, but one of the children happened to have an illness that is pretty severe. As we all know, the new legislation guarantees that the 7 year old, named "Timmy", can get coverage. We quoted Timmy at a base monthly rate of $100. As underwriting proceeded we expected to see Timmy rated up as much as 2 times or a worst case 3 times. Unfortunately we received startling news. Timmy was insurable with this company for an astounding 800% rate up! The family was going to pay a quoted rate of more than $2,000 a month!
I'm not sure about you, but in my experience, there are not many clients that step up to the plate and obtain insurance that is rated up 800%! The decision is laughable and brings to light the contrast between good intentions and the practical implementation of any plan. Clearly the coverage is unaffordable, so the Health Reform Act has missed the mark on meeting the objective in its name!

In our office we need to do more research on the case and determine if the child is insurable under the Texas High Risk Pool since technically this child is insurable with a carrier. Are they denied insurance in the pool because they do have access to coverage? I would guess that the PCIP plan too is out of reach for the child. CHIPS and Medicaid are also not options for this family.
This is just another reason for an overhaul of the overhaul.

Jason W Bohmann
Texas Health Design