More than 20,000 people rely on the state run Texas Health Insurance Pool. The pool insures folks with pre-existing health conditions who can’t find coverage elsewhere. In a few months, that risk pool will no longer exist. And at least one North Texas family is celebrating.

The KERA radio story on the Flood family.

Right after he retired a decade ago, Bob Flood learned he had cancer and a kidney would have to be removed. Just one month after he lost his kidney, he lost his health insurance.

Bob and Amy Flood, at their home in Allen, TX. The Floods used to buy health insurance through the Texas Health Insurance Pool because of pre-existing conditions, but now are able to buy plans on the health insurance marketplace.

Lauren Silverman/KERA News

Bob and Amy Flood, at their home in Allen, TX. The Floods used to buy health insurance through the Texas Health Insurance Pool because of pre-existing conditions, but now are able to buy plans on the health insurance marketplace.

“They called me up and said we’re canceling your policy,” Flood says. And not just for him, his entire family.

Flood, who lives in Allen with his wife and two sons, figured he’d find another policy. But he was refused, over and over again.

“The only place I could get health insurance was through the Texas health risk pool. And that is 200 to 400 percent above what the average person pays,” Flood says.

Life In The Texas Insurance Pool

The Texas Health Insurance Pool was created in the 90s to cover people with pre-existing conditions, like cancers and heart disease. Pool insurance rates are required, by law, to be twice the rates on the commercial market – an average of $700 a month.

Flood’s family policy was more than three thousand a month. His wife Amy says they tried to write the check once a year to avoid seeing the bill so often.

“That was a sizeable chunk of change,” Amy Flood says. “And frankly I would have rather given it to other needy people rather than just to an insurance consortium.”

But the Floods wanted to be responsible, so they agreed to grin and bear it. Thanks to the Affordable Care Act, they don’t have to anymore.

“Now we have a policy which covers the three of us for less than a thousand dollars a month.”

See, Obamacare means insurers can no longer deny coverage to people with pre-existing conditions. That means the expensive lifeline that was the insurance pool is no longer necessary, and tens of thousands of people who were unable to buy on the private market in Texas can finally choose from a variety of plans.

Choices On The Marketplace

Stacey Pogue, of the Center For Public Policy Priorities, says not everyone will find thousands of dollars in savings like the Floods.

“Some people will pay more and some people will pay less,” Pogue says. “And part of that’s going to depend on which plan they pick. But one thing that can be said across the board for the risk pool is that they will actually have a plan choice that they haven’t had in the past that includes different insurance companies and different networks.”

Of course, that depends on healthcare.gov working.

The idea of closing down the insurance pool, Pogue explains, was contingent to the marketplace being there to pick everybody up.

“If problems continue and make it difficult for people who are in the risk pool to enroll, we’ll need to have a conversation as a state about whether it makes sense for the risk pool to stay open a little longer,” she says.

Since there are people, like the Floods, who have successfully made the transition, Pogue says it’s not time to call for a delay yet, and don’t even talk about repealing Obamacare with Bob Flood.

“What do you want to repeal, do you want to repeal the pre-existing clause?” Flood asks. “That would mean cancer survivors like me couldn’t get insurance.”

So no matter how bumpy the roll-out, for folks like Bob Flood, there’s no turning back.

  • Jeff Andonian

    What some fail to realize, is to how many people did not qualify for traditional insurance, in Texas because they were considered “High Risk”.

    If one was is 50, overweight, has high blood pressure, elevated blood sugar and is self-employed or works for a company that does not provide health insurance good luck trying to find a company that will insure you outside of Texas High Risk Pool.

    I have a relative that fell into that profile. That relatives only option for health insurance was the Texas High Risk Pool at $800+ plus per month, per person for her and her husband.

    However, thanks to the Affordable Care Act, she now has health insurance and at the affordable price of $301 per month, and by the way, that does include annual mammograms and lower GI’s with zero deductible.

    • http://www.goatmug.blogspot.com/ Goatmug

      Jeff, tell us more. There’s got to be more to this $301 rate than you are explaining. First, the Texas High Risk pool is expensive, but frankly, it is pretty good, it’s a PPO administered by Blue Cross and has a large network.

      I’d be willing to bet that the $301 rate you quote is for an HMO product, meaning that the network size is about 20% to 25% of the PPO network (even if you stay with a Blue Cross HMO).

      Second, the $801 premium your relative was charged probably indicates that they had a lower deductible plan somewhere around a $2,500 deductible and $3,000 of co-insurance totalling $5,500 out of pocket. The new plan your relative is getting probably has a cap at $6,350 which is the maximum allowed for an individual by the ACA. This isn’t horrible, but it isn’t great since this is about 15% more out of pocket costs, but when compared to the net premium you quote it would be a no-brainer. I point it out though because advocates of the ACA never point out that often we are paying more out of pocket.

      Third, the $301 rate sounds so good, it is probably the “net” rate after your relative receives subsidies (code for taxpayer money). While that is good for her, it probably isn’t good for the solvency of the ACA program and the US taxpayer. It isn’t good for the solvency of the program because it relies entirely on the notion that all the healthy people will sign up and pay more than they should so your relative can pay less than he/she should. I am happy that she/he is receiving decent care at a much more affordable price, yet I’d rather you state that the cost of the new plan (equivalent or not) is really $750.00 a month and yet with subsidies (tax-payer funding) the net cost is $301/month.

      I focus on this because the proponents of the ACA NEVER really suggest that there are real costs to this program that often times are the same or higher than current costs. I’d bet that the Texas High Risk pool actually was actuarially sound and wasn’t destined to run out of money like the Federal PCIP Program which ran out of funding 8 months earlier than expected. If the PCIP program is any indication of how the government will be able to manage the costs of the ACA, I’m guessing that your relative may have the plan at these great rates for one year and then she/he will be subject to 20% to 50% increases in premiums. Remember, math doesn’t lie, it just takes a while for the reality of math to actually hit home.

      • Art Garcia

        Good Point

  • Jeff Andonian

    The plan has a $2,000 deductible and a $6,250 maximum catastrophic out-of-pocket and no lifetime cap. Please check out the summary of benefits, on page 77 of the following link http://www.pciplan.com/forms/pdfs/2013Brochure.pdf

    I know that all of the family members physicians have accepted the plan. Also please note that I had incorrectly stated that the monthly premium rate was $301 per month. It is actually $319 per month.

  • wbrosche

    My story is the same. As a customer of a Blue Cross plan in another state, I was paying $1400 per month for me an my wife. When I moved to Texas, I was guaranteed the ability to transfer to BCBS TX. Notice that the transfer was guaranteed, not the price. BCBSTX wanted more than $3800 per month for the exact same coverage because of a few fairly benign pre-existing conditions for which insurance did not even pay for the prescriptions because it cost less than the copay.

    So this summer, we joined the high risk pool. Out-of-pocket is quite a bit higher and not as good as the policy I had while only costing around $950 per month. Now with the ACA, BCBSTX will be selling me the same coverage I had previously for less than what I was paying before we joined the high risk pool

    • Art Garcia

      And since the ACA was passed Blue Cross Blue Shield like the others companies are having to come up with more expenses with the requirement that kids who are living with their parent until 26 years old have to be covered and that pre-existing coverage cannot be denied. In other words BCBS is have to take on more risk. And remember they are a non-profit.

  • wbrosche

    My story is the same. As a customer of a Blue Cross plan in another state, I was paying $1400 per month for me an my wife. When I moved to Texas, I was guaranteed the ability to transfer to BCBS TX. Notice that the transfer was guaranteed, not the price. BCBSTX wanted more than $3800 per month for the exact same coverage because of a few fairly benign pre-existing conditions for which insurance did not even pay for the prescriptions because it cost less than the copay.

    So this summer, I joined the high risk pool. Out-of-pocket is quite a bit higher and not as good as the policy I had while only costing around $950 per month. Now with the ACA, BCBSTX will be selling me the same coverage I had previously for less than what I was paying before we joined the high risk pool

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