A special task force has recommended to Gov. Norm Bangerter that a special risk pool be established to provide catastrophic medical cost insurance for up to 6,000 medically uninsurable Utahns.
The risk pool should include no less than all insurance plans, including the plans of self-insured employers now exempt from state regulation by federal law, the Task Force on Catastrophic Medical Expenses said.And AIDS should be treated in same way as any other medical condition that precludes persons from getting medical insurance, the panel said.
The program, recommended to be set up as a private entity, should not be attempted until all third-party payers are brought into the risk pool. That would include those large employers who are self-insurers, who provide 50 percent of the present coverage and who are presently exempt from regulation under federal law, said Michael J. Stapley, committee chairman.
That change, he said, could be made by Congress as early as this year.
The panel has worked during most of the current administration to form a plan to recommend to the Legislature, Stapley said. A recently-passed Senate joint resolution calls on the Legislature to study the problem in the session interim this summer.
The task force found that with most of the estimated 6,000 Utahns participating, a deficit by the fifth year would amount to $6.5 million that would be borne by the insurers.
But no industry cooperation would come, or be expected, unless the 50 percent of companies now exempted are brought into the plan through an amendment to present federal law, he said. These companies are self-insurers whose funds aren't technically considered to be insurance under the present law.
The participants in the plan would be expected to pay from 125 to 150 percent of normal premiums. As it happens, some 70 percent of medically uninsurable persons in the target group are poor, so there must also be a way to make their premiums more affordable, he said.
The additional amount would be borne by the state, which would pay a premium subsidy of about $150,000 per year, the group said.
Persons who typically cannot buy medical insurance at any price include AIDS sufferers, alcoholics and individuals with any of a number of diseases and medical conditions.
The report states that some 260,000 Utahns (17 percent of the population under 65) are without health insurance, and of these, 6,000 are uninsured for medical reasons.
The group recommends a single, comprehensive major medical plan, with uniform coverage levels for almost all covered services. These would include a $500 annual deductible, with a sliding scale subsidy according to income, 20 percent coinsurance on covered expenses in excess of the deductible, a $1,500 per person ($2,500 per family) yearly cap on out-of-pocket expenses and a $1 million lifetime maximum benefit.
To be eligible, individuals would have to provide proof they'd been rejected for insurance or quoted a price in excess of the pool's rate. Eligible persons would include those rejected either for hazardous occupations or lifestyles or with medical conditions that almost always lead to rejections.
Those who receive Medicare would not be eligible, nor would healthy family members of an eligible individual be eligible.