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Sick Oklahomans welcome new coverage alternatives

Several Oklahomans now insured through stopgap Temporary High Risk Pool say they welcome new choices that will be available in the coming year with the Affordable Care Act.
by Paula Burkes Published: September 22, 2013

Soon after President Barack Obama signed the Affordable Care Act into law in March 2010, Cheryl Martin's husband asked her to start looking for a health insurance policy that would cover them both. Neither had insurance.

While their three children were growing up, he'd traveled nationwide as a contractor to oversee the construction of compressor stations for transporting natural gas. She minded the home fronts in Lamar and now Bartlesville.

Martin found coverage for her husband but, because of a stent in her heart, she was turned down. She was referred to the Oklahoma Temporary High Risk Pool, whose members must be legal U.S. residents and have gone uninsured for six months or longer.

The pool, and other states' temporary pools, were created by the Affordable Care Act and funded by the federal government to serve as a bridge for the sick until 2014 — when insurers can't deny medical coverage based on pre-existing health conditions and new online health insurance marketplaces will be available offering affordable insurance.

It wasn't but six weeks after Martin joined the high risk pool that she — in sudden, severe pain — went to the emergency room, where doctors diagnosed her with two broken ribs, pneumonia and, after several tests, lung cancer, she said.

“Let me tell you, I felt thankful — blessed — to have the insurance,” Martin, 50, said. “I'd learned from experience that they won't hardly help you if you don't have it.”

Cancer treatments are unbelievably expensive, said Martin, who's had more than $950,000 in care.

Focus on transition

Martin is among some 900 Oklahomans covered under the temporary high risk pool who must roll off it at midnight Dec. 31. An additional 2,676 on the 17-year-old state high risk pool are expected to transition to the coverage under the new marketplace, before open enrollment ends March 31.

A Colorado customer of Martin's husband, who offers workers health insurance, recently hired him so that Cheryl Martin would have coverage. But at least two temporary high risk pool members already are planning to shop for new policies in Oklahoma's new federally run online health insurance marketplace: the single mother of a 19-year-old Tulsan who suffers from a rare, life-threatening, colorectal condition, and a 34-year-old Carney man with liver complications who, through compounded bad luck, lost his home and business in the May tornadoes.

“At this point, our primary focus is transitioning members to the exchange,” said Tanya Case, executive director of the temporary high risk pool.

Administered by Blue Cross and Blue Shield, the pool has annual medical and prescription drug out-of-pocket deductibles of $2,000 and $200, respectively.

Premiums run from $128 a month for nonsmoking members 18 and younger to $746 for smoking members 60 and older.

By comparison, most monthly premiums on the new insurance marketplace will cost between $200 and $700, based on consumers' ages, tobacco use and where they live in the state, according to a recent report by Oklahoma Watch. That's before federal subsidies, which will be based on income and family size, for which Case expects most members to qualify.

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by Paula Burkes
Reporter
A 1981 journalism graduate of Oklahoma State University, Paula Burkes has more than 30 years experience writing and editing award-winning material for newspapers and healthcare, educational and telecommunications institutions in Tulsa, Oklahoma...
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