Senator Lucio's Letterhead

CAPITOL UPDATE FROM SEN. EDDIE LUCIO, JR.

FOR IMMEDIATE RELEASE
April 17, 2008
CONTACT: Doris Sanchez , Press Secretary
Phone: (512) 463-0385

Texas Health Insurance Risk Pool Needs Expansion and Publicity

The Senate Committee on State Affairs, on which I serve, is reviewing a program sponsored for medically uninsurable Texans that should be better publicized and expanded.

The Texas Health Insurance Risk Pool (THIRP) was created by the Legislature in 1989 for people unable to obtain health insurance. However, the program lay dormant until funded in 1997 to comply with the federal Health Insurance Portability and Accountability Act (HIPPA) of 1996. In 1998, the Pool's nine-member Board of Directors was appointed.

To be eligible, a person must be a Texas resident under age 65 who is either a U.S. citizen or permanent resident for at least three years and who meets one of three criteria. The person must be rejected by an insurer for health reasons or accepted but with a medical condition excluded; be diagnosed with one of the 55 medical conditions on the Board's list; or be certified by a Texas insurer that the person would be denied coverage.

Also, certain conditions disqualify people from THIRP, like coverage by or eligibility for an employer-based health plan, except for COBRA eligibility or part-time limited coverage. Other eliminators include termination or lapsed Pool coverage within the prior 12 months, jail or prison confinement, Pool coverage terminated for fraud, the lifetime maximum benefit of $1.5 million under the Pool's prior coverage was exhausted, or if another entity can pay the premiums. Enrollees without prior THIRP coverage are generally subject to a 12-month pre-existing condition exclusion.

Since 1998, 62,000 have been covered by this program and paid 63 percent of the costs, while private insurers have covered 36 percent of costs that increase yearly about 13 percent.

Only two Texas counties have over 3,000 people insured by this program. Most counties like Kenedy, Kleberg and Willacy have from up to 150 members and a smattering of counties that include Hidalgo and Cameron have from 150 to 400 members. The high premiums and out-of-pocket expenses combined with a lack of awareness keep enrollments low.

Although many cannot afford the plan, often those who can are unaware of the Pool's existence or eligibility requirements. More effort must be made to inform the public. Notification of THIRP in every workplace should be required, especially where there is no health insurance plan available.

To make the Pool more affordable but not competitive with the commercial market, we must look at additional funding sources. Pool premiums that average $540 monthly are set by law at 200 percent of the "standard risk rate," or twice the average rate available in the commercial market. It is worthwhile to investigate if THIRP can remain viable at lower percentage rates.

In the last two years, THIRP received $9.2 million in federal funds from the State High Risk Pool Funding Extension Act of 2006 to reduce member premiums and insurer assessments. In 2007, 180 insurers made payments to the Pool ranging from $7 to $21 million. Also last year, $162.4 million medical and $77.6 million pharmacy claims were paid by the Pool. As medical and prescription costs continue to rise, so do health insurance premiums, thus any funding increase is being swallowed by health care costs.

In 2006, enrollment was 28,206, dropping to 27,773 in 2007. Premiums are still too high and out-of-pocket expenses that include deductibles ranging from $1,000 to $7,500 continue forcing many to cancel THIRP, even if employed.

According to the Texas Medical Association, "Texas ranks 49th in the nation for employer-sponsored insurance; only 54 percent of Texans have coverage through their employers." For small businesses - the bulk of Texas employers - the number is even worse: 37 percent."

Although I have been pro-business throughout my legislative career, I have also always been pro-employee. Our workers are the backbone of business, so perhaps certain types and sizes of businesses that don't offer health coverage could contribute funds on a scale similar to medical insurers.

Business benefits when employees get regular health check-ups and care because they are usually healthier than those who wait until their conditions are so severe that they must obtain emergency care.

It is apparent that THIRP needs a financial booster to meet Texas's growing demands and to help more medically uninsured Texans. Since 80 percent of Texas businesses are small businesses often unable to afford employee health insurance, their participation in the Pool could help, as well as make premium rates more affordable for all participants.

The stated mission of THIRP's Board of Directors is to: "Foster public awareness of the Pool and provide eligible Texans with cost-effective health coverage that is consistent with major medical policies available in the commercial market." My goal is to help the Risk Pool to fulfill its notable mission and add more Texans. Note: For information on THIRP, please call 1-888-398-3927, TDD 1-800-735-2989, or email texasriskpool@bcbstx.com.

As always, if you have any input or questions regarding these or other matters, please do not hesitate to contact Doris Sanchez, my press secretary, 512-463-0385.

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