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North Carolina is offering insurance to people with pre-existing medical conditions

Robert C. Reed | Hickory Daily Record

Amber Holder, an accounting director with Carolina First Associates, discusses insurance options with Wes Jackson, of Charlotte, during an information session at Catawba Valley Medical Center on Monday.

By Ragan Robinson | Hickory Daily Record

Published: October 12, 2009

HICKORY - Until he sat down with an agent at Catawba Valley Medical Center on Monday, Randy Whisnant said insurance companies wouldn't even talk to him about coverage.

The 53-year-old heating and air conditioning worker had heart bypass surgery in September 2002, before his employer stopped offering group health insurance.

That means the Icard resident has a pre-existing condition, an almost insurmountable hurdle to getting health coverage.

"It's like I'm a dead man walking," Whisnant said, referring to how quickly agencies denied him private insurance.

Representatives with Inclusive Health were in Hickory on Monday to spread the word about the program, which provides health insurance for people with pre-existing conditions and an inability to get group coverage, Medicare or Medicaid.

The state General Assembly created Inclusive Health, also known as the N.C. Health Insurance Risk Pool, in August 2007. The program began enrolling people in January.

The bill that created the insurance program says it should be run so premiums cover the cost of providing the benefit plans. Inclusive Health also must charge rates that are no less than 175 percent of what private insurers charge, ensuring it won't compete with private insurance companies.

So the option isn't cheap. An average person pays a $550 premium every month. Inclusive Health's executive director said that could still be hundreds less than a person with a pre-existing condition would otherwise pay for coverage.

"Typically there's a savings of 50 percent," said Michael Keough, executive director.

The group bases the price of individual plans on age, sex and whether the person smokes instead of on the disease he or she has.

That means a child's policy could cost $100 to $200 a month, according to Keough.

He said a federal grant would soon qualify some people for a subsidy to reduce rates by 20 to 43 percent.

Others, including unemployed people who lost their jobs to overseas markets, qualify for subsidies that cover up to 80 percent of the health insurance costs.

None of that will help Whisnant, who said there's no way he can afford the $580 monthly premium he would have to pay.

"I don't know if it's any help or not," he said.

But Zack Taylor, 42, of Hickory, said he would be looking for a way to pay the $240 it would cost him monthly for Inclusive Health benefits.

He doesn't have a job, and he's never had health insurance. His medical history makes it difficult at best to obtain coverage now.

Taylor said he has diabetes, blood clots in his heart, blood clots in his lungs, two broken discs in his back, high blood pressure and high cholesterol.

His last hospital stay, from May 30 to June 2, cost him $19,764, Taylor said.

More recently, he got a $3,830 bill for having teeth removed.

Taylor said he's having trouble staying current on his $20-a-month payment plan to cover his medical bills.

The cost might be more than he can pay but Taylor said he appreciates finding a policy that would cover him.

Inclusive Health provides insurance benefits for 2,263 people in North Carolina. Keough said an estimated 200,000 people in the state lack health insurance because of pre-existing conditions.

More than 54 percent of those enrolled in Inclusive Health are people who have exhausted their COBRA coverage. COBRA is the program that allows people who lose jobs to extend benefits for up to 18 months.