Pre-existing conditions still hinder insurance coverage

Many patients can’t pay the price or meet requirements of high-risk insurance pool.

Hundreds of Ohioans have enrolled in a temporary high-risk insurance pool established under the new health care reform legislation to help those with pre-existing medical conditions find coverage. But the high cost and stringent qualifications have left many of those eligible sitting on the sidelines.

One of them is Perri Ballard of Washington Twp. “Insurance for people like me with pre-existing conditions is a fallacy,’’ said Ballard, who has an inflammatory bowel disease and was laid off from her job as a customer adviser at LexisNexis nearly two years ago.

Although Ballard is uninsured, she has been effectively barred from the high-risk pool coverage because she hasn’t gone without coverage for six months — a requirement for coverage.

Even if she could qualify for one of the two high-risk plans offered by the state, she’d struggle to afford the monthly premiums, she said.

Like thousands of other Ohioans, Ballard is on the brink of exhausting the maximum 99 weeks of unemployment benefits, which is her main source of income.

“We will never be able to get (health insurance) or afford it unless we are under an employer’s group plan,’’ said Ballard, who lives with her 14-year-old daughter. Her monthly premiums would range from $312 to $344, depending on deductibles.

Carly Glick, a spokeswoman for the Ohio Department of Insurance, said despite its shortcomings, state officials are satisfied with the participation in the program, which is administered by the state through the nonprofit Medical Mutual of Ohio.

At least 777 Ohioans, including 112 in the Miami Valley, have enrolled in the insurance pool, which is in line with the state’s projections. However, the figures represent only a small fraction of the hundreds of thousands of unemployed workers and employees of small firms who typically can’t get insurance because of health conditions and would qualify for the program.

“What you have to understand is this is a federal program, and we’re bound by federal requirements,’’ Glick said. “We can’t change that.’’

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