Group moves to bridge insurance GAP

America’s Health Insurance Plans, an industry trade group, today unveiled a proposal to provide health insurance coverage to more people — even those with existing health conditions. The pitch would encourage states to create a Guarantee Access Plan to cover uninsured individuals with the highest expected medical costs. This new model is loosely based on high-risk pool state plans, and AHIP will work with state legislators to discuss the GAP. If customers are initially denied private coverage, they can apply to this plan if the costs of their health care claims are greater than or equal to twice the statewide average. Those who are ineligible to join the Guarantee Access Plan can receive guaranteed coverage from health insurance plans, with premiums capped at 150% of standard market rates. Exclusions for pre-existing conditions will not be imposed by the GAP or the health plans if the consumer maintains continuous coverage. Once the GAP is established, there would be a one-time open enrollment for the uninsured to receive coverage with no exclusions for these conditions. Though guaranteed issue plans tend to raise premium rates for all who are insured, AHIP provides some recommendations for states to ensure affordability. This includes implementing disease management and preventive care programs, providing payment incentives and benefit designs, and creating a sliding-scale premium subsidy program, plus help for those with high health costs. “We know that some states have looked at financing for existing risk pools by looking at the individuals purchasing coverage,” said Karen Ignagni, president and CEO of AHIP, in a conference call. “That burden falls disproportionately on them.” “The objective here is to ensure that no one falls through the cracks,” she added. “It’s very important that we not repeat the past.”