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Program provides affordable health care for pre-existing conditions

Posted October 7, 2009

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— It's a dreaded phrase among those in need of health insurance: "pre-existing condition."

But in January, a statewide program called Inclusive Health went into effect that insures people with medical conditions who are not eligible for Medicaid or Medicare.

Pre-existing conditions? Get more affordable health insurance Pre-existing conditions? Get more affordable health insurance

"Healthy people can find a better deal out in the commercial market," said Inclusive Health's executive director, Michael Keough. "We're set up as the insurer of last resort – sort of a safety net, if you will."

The average monthly premium, Keough said, is $570.

"If we're lucky, premiums cover about 60 percent of our costs," he said. "The other 40 percent is made up of state subsidies."

Subsidies are derived from surcharges on existing health plans, state Rep. Rick Glazier, D-Cumberland, said.

"It's going to vary year to year," he said. "And several million dollars are put in – it's a variable amount."

An estimated 1.3 million North Carolinians have no health insurance. Inclusive Health estimates about 169,000 of those are eligible for the program. It also says there could be another 9,000 people who have insurance but who would pay lower premiums under the plan.

About 2,200 people have enrolled since Jan. 1.

For Sonya Pinnix, of Vass, the program is a "godsend."

Multiple sclerosis forced her out of her job at an assisted-living facility two years ago. Her health benefits eventually ran out, and she had to find another policy on her own.

With her pre-existing condition, she faced a $1,200 premium.

"It was just unimaginable," she said. "Some of those insurance companies didn't even cover a specialty drug that I'm on for multiple sclerosis."

Lin Walker said one company after another turned her down because of thyroid and breast cancers She, too, heard about Inclusive Health.

"It's not for me right now, but it's very comforting to know that it's there, should I need it," she said.

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