Ohio Consumers for Health Coverage

The Governor’s budget contains a modest provision to help people with pre-existing conditions buy affordable health insurance. But the insurance industry is working hard in the Ohio House to weaken or gut this proposal, which would help 52,000 Ohioans with pre-existing conditions get affordable coverage. Who will win, Ohio consumers or the insurance industry?
Ohioans not offered employer or group health insurance coverage are left to purchase insurance coverage in the individual market, where many consumers are denied coverage or charged unaffordable premiums. Ohioans hit the hardest are those with pre-existing conditions. Coverage for them is often denied or offered with exclusions for treatment for pre-existing conditions—care that people need the most.
Ohio created the Open Enrollment Program for people denied coverage in the individual market. Under Ohio law, health insurers must open enrollment annually. Insurers may not refuse anyone, regardless of pre-existing conditions, until they reach their enrollment cap. But the premiums in the Open Enrollment Program are so high that, in 2007, only 1,487 Ohioans enrolled for coverage during the open enrollment period.
Governor’s Proposed Modification to the Open Enrollment Program
HB 1, the Governor’s budget, modifies the Open Enrollment Program by lowering the cap on premiums for people with pre-existing conditions. Lowering the cap will enable a significant number of Ohioans with pre-existing conditions to afford coverage, by spreading the risk over the whole individual market. Actuaries hired by the Ohio Department of Insurance measured the impact of different premium caps (their report can be found at http://www.healthcarereform.ohio.gov/HCRDoc/LandEOpenEnrollment.pdf).
The study concluded that by capping open enrollment premiums at 1.5 times the base rate for coverage, which the Governor recommends, premiums (rates) spread across the whole individual market would increase by an average of 5.5 percent and a net of 52,000 Ohioans will obtain coverag, most of them with pre-existing conditions at rates 50 to 70% lower than the extremely high rates charged to them under the present law.
To lower the 5.5% increase across the whole individual market population, the premium cap for Open Enrollment could be raised. But that will lower the number of people with pre-existing conditions who will benefit from the proposal to 14,000, a drop of 73 percent! Here are some of the alternative findings of the actuary:

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