Randy Dotinga, Author at ��ϳԹ�� News

Solo Coverage For $430 A Month? For This Enrollee, It’s A Deal

Randy Dotinga — Wed, 22 Jan 2014 10:00:02 +0000

This post is Randy Dotinga’s��latest update��on��his efforts to secure health insurance as a single,��freelance writer with pre-existing��conditions.��You can also read��his earlier installments, and .

After 13 years of being an insurer’s worst nightmare, I just heard some wonderful words: The insurance company will see you now.

Randy Dotinga

They even gave me coverage. Darned good coverage, in fact, for $430 a month for my single, middle-aged and pre-existing-conditioned self.

Cheap? No. Priceless? Yes — especially after the steady stream of state and federal bureaucratic hassles that have plagued me for the last several months; and, before that, years of individual market coverage from insurers that abandoned me, turned out to be fraudulent or raised my rates into the stratosphere.

My experiences show that the health coverage can be a difficult proposition . Until recently, my only feasible option to remain insured was to cough up $748 a month for shoddy coverage via California’s high-risk plan.

Then the Affordable Care Act provided��new options��for folks like me, but only if I went . I crossed my fingers, and got through the hiatus without a scratch. That was in 2012.

This coverage, through the California Pre-Existing Condition Insurance Plan at $265 a month, took me through June 2013. Then it expired, and I had to switch to yet another temporary program, the federally run Pre-Existing Condition Plan, at $287 a month.

And finally, it was��Jan.��2014,��and I could��find a health plan��through Covered California, the state’s online insurance marketplace.

After signing up for a Blue Shield of California plan, I received a letter the other day telling me that I could have extended the federally run Pre-Existing Condition Plan through January “to prevent a lapse in coverage.” Too late: I was already covered and therefore ineligible for an extension.

I could have saved $143 by sticking with the federal plan for another month instead of joining Blue Shield. But I might as well get used to it. Yes, I’m now paying $430 a month instead of the $265 or $287 I paid in 2012 and 2013, but it still beats the days of paltry coverage for a premium with a price tag in the $700s.

The transition has not been entirely smooth, though. For instance, after I used the California exchange to enroll in my new plan, I worried over the non-arrival of a bill from Blue Shield that would acknowledge my coverage and provide my policy number. It finally came at nearly the last minute, urging me to pay pronto and mentioning a previous bill that had never arrived.

I’m definitely insured now, though. My payment, which I made online, went through, and my insurance ID card showed up in my mailbox. It was two weeks late, since my coverage began on Jan. 1. But it’s here, I’m covered, and I’m glad.

��ϳԹ�� News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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My Other Pre-Existing Condition: Unstable Insurance

Randy Dotinga — Mon, 28 Oct 2013 19:32:00 +0000

I’d like to start a long-term relationship with a health plan, but all I’ve had are flings — seven insurers in the last 13 years. Is it something I said? Nope, it’s something I am: a self-employed, 45-year-old single guy with a heart that beats funny.

One of freelance writer Randy Dotinga options for insurance this year was a $3,028-a-month guaranteed-coverage Point of Service plan from Cigna.

Take Cigna. We seemed to click until the company wanted me to pay $11,000 a year in premiums. Another insurer came calling but turned out to be a scam, defrauding me and thousands of others. The high-risk plan in California — my home state — took me on, but I had to cough up $700-plus a month for paltry coverage.��

Another couple of government-run plans were supposed to get me through this year with cheaper rates, but a bureaucratic snafu snuffed my coverage.

At least my misery has company. People with pre-existing medical conditions “face every kind of possible hassle,” said Nancy Metcalf, a senior program editor with Consumer Reports. Many can’t find coverage at all.

Now 2014 is fast approaching, and I suddenly have suitors. Six companies are offering me 34 plan options through my state’s marketplace, which was created under the federal health law. Insurance coverage, at last, is guaranteed. And, for now, so is confusion.

It’s A Long Story Involving A Scam, An $11,000 Annual Premium And Relief (Kinda)

My endless insurance drama began in 2001, when my COBRA coverage expired from my previous newspaper job. I needed to find new coverage on the individual market as a self-employed freelance writer who didn’t have access to a guaranteed group health plan. But insurer after insurer rejected me because I had a pre-existing condition: an irregular heartbeat I’d developed in my 20s.

The condition, known as atrial fibrillation, slightly raises my risk of stroke. It also requires occasional cardiologist checkups and costs about $260 in medication each year. That was enough to make me one of the millions of people on the individual market who can’t get coverage because insurers��don’t want to risk paying extra for their health problems. (I like to imagine that insurance companies ran screaming into the night when they received my applications).

I needed to find the individual insurance market’s Holy Grail — an insurer who’d take all comers, pre-existing condition or no. I discovered it through a writers’ group that sold an Aetna insurance policy, no health questions asked. But then Aetna spiked its rates, and the group found replacement insurance through a company called Employers Mutual. This did not go well.

The company�� to be��, leaving me and 29,000 other policyholders in the lurch. Employers Mutual reportedly left��tens of millions of dollars in medical claims��unpaid.

Coverage through Cigna came next via�� that provides coverage to members of associations representing artists, performers and writers. But in 2006, when I was 38, I faced a prohibitive increase in my monthly premium from $509 to $928. (The Cigna rates are even worse now. My annual premium for 2013 if I bought a�� through the same company: $3,028 a month, or $36,336 for the year, plus a $24 service fee.)

A lack of options forced me to enroll in California’s��, and it cost me big-time. My monthly premium grew over time and by 2008 it was more than $700 a month for coverage with an annual benefit limit of $75,000 and a lifetime limit of $750,000.

As Metcalf of Consumer Reports puts it, that level of coverage is “terrible.” Indeed, a serious car accident or bout with cancer could wipe that out quickly.��I worried that an expensive medical catastrophe would mean bankruptcy for me.

So I paid.

Left In The Lurch Once Again

Fast forward to the Affordable Care Act. For me, it is shaping up to be a blessing — sort of��— in my case.��

The health law set up a new state insurance plan for high-risk people – the California Pre-Existing Condition Insurance Plan – that offered me the opportunity to get fantastic benefits at less than half the cost of my existing coverage. But I had to go without any insurance for six months to��qualify.

So I did, and I survived. But this plan, at an exceptional price of $265 a month, expired in June of this year, forcing me and�� into a six-month��.

That brought more trouble. I’ve been paying the $287 monthly premiums for the transition plan, but a visit to the doctor’s office this month for a flu shot revealed that the feds cancelled my coverage back in August. The system seems to believe I’m eligible for Medicare. Actually, I have another 20 years. Now, I’m working through a bureaucratic maze of phone calls and emails to restore my coverage for the remainder of this year.

That’s just one spot of bother for me to resolve. There’s another: Now I need to wade through 34 insurance options from Covered California, the , which was created as a result of the health law,�� and figure out which one to purchase for 2014.

Choices, Choices And More Choices��

Fortunately, I live in one of the 14 states that operate their own marketplaces and don’t��rely on healthcare.gov, the trouble-prone federal website. Unfortunately, the Covered California website has had its own , including�� search feature and shutdowns of the enrollment section for repairs.

So far in my efforts to enroll, which��began shortly after the Oct. 1 launch, I’ve faced numerous impediments — blackouts when the site was shut down for scheduled maintenance, a disappearing enrollment section and other technical hiccups, including broken links and HTML coding problems.

Still, I’ve found the website easy to use when it’s actually working. It says 34 plans are available to me ranging in price and particulars from $263 a month for��in an exclusive provider organization to $548 a month for a “platinum” level health maintenance organization.

The “metal” levels — bronze, silver, gold and platinum — refer to the level of coverage offered by a plan. They�� from platinum plans that cover an average of 90 percent of health care costs to bronze plans, which have significantly cheaper premiums but cover only 60 percent of costs and have higher deductibles. (They pay for 100 percent of costs after a policyholder reaches a set out-of-pocket spending limit.)

The state standardized the four general types of coverage levels so they share the same deductibles and co-pays, said Anthony Wright, executive director of Health Access California, a non-profit advocacy group. “This is a huge benefit for consumers because it creates a situation where people can actually make apple-to-apple comparisons, and it removes the fear of the fine print.”

34 Different Of Apples

But I’ve still got to compare 34 different apples. And it’s not just Granny Smith versus Red Delicious, even with California’s user-friendly modifications.

There are many factors to consider just to choose the best metal level. Platinum plans cover a lot with no deductible and a low, $4,000 maximum out-of-pocket expense for an individual, but they’re mighty pricey and a bad deal if I don’t need much care. Bronze plans could save me thousands of dollars a year in premiums versus platinum plans, but they don’t cover much and have a higher out-of-pocket maximum — $6,350.

(My income is too high for me to be eligible for��subsidies to reduce my premium or��costs like co-pays. The Covered California website says I’d get an $11 a month subsidy if I made $45,000 in “” a year��or a whopping $207 monthly subsidy if I made $25,000.)

The Covered California website had a handy feature that asked me how much I typically spend on medical costs annually and then estimated how much I’d spend each year, per plan, on premiums and out-of-pocket costs. But that feature seems to have disappeared for the moment, along with the enrollment section.

Then there are the other factors: HMO, PPO or EPO? If I’d like an HMO, I could go with Kaiser Permanente, which insures 7 million Californians and is well-respected, but would require me to dump my current doctors. HealthNet has by far the cheapest gold-level HMO plan at $347 a month, a savings of $552 a year over the next cheapest one.

But the state website’s failure to provide a working database of the physicians covered by the various plans leaves me in the dark about whether HealthNet HMOs include the doctors I’ve seen for a decade or longer. And I know HealthNet has tried to lower costs to policyholders by�� the number of doctors who are covered by its plans. So has Blue Shield of California, which will make�� to those who buy coverage through the marketplace, the LA Times��reported.

Soon, though, I should have coverage set up for 2014 that will be thousands of dollars cheaper a year than what it once was — although more than I’m paying now — and cover much more.

Who knows, maybe an insurer and I will finally start going steady.

Randy Dotinga is a freelance writer based in San Diego.

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San Diego Hospice Will Close As Financial Problems Grow

Randy Dotinga — Thu, 14 Feb 2013 15:00:55 +0000

San Diego Hospice, one of the nation’s oldest and busiest, is closing its doors permanently in response to financial problems stemming from an investigation of its practices by Medicare.

The hospice announced last week that it . On Wednesday, San Diego Hospice said it would cease operating in the next 60 to 90 days and that Scripps Health has offered to buy the hospice’s small hospital and hire hospice employees to care for current patients.

Medicare has been investigating whether the hospice has complied with government rules governing admissions and length of stay of patients, who require physician documentation that they are not expected to live more than six months. The ongoing prospect of loss of funding by Medicare drove Wednesday’s action.

“The plan we have put forward will allow us to take immediate steps to stop incurring debt, which increases every day we remain in operation,” , CEO of San Diego Hospice, said in a .

The hospice had served as many as 1,000 patients at a time, but that number tumbled to 600 in recent weeks as the hospice laid off hundreds of workers and closed its 24-patient hospital.

Scripps Health, led by president and CEO , is a $2.6 billion nonprofit system with five acute-care hospitals.

Federal officials are looking more closely at hospices to determine their compliance with the rules. At the same time, hospices are receiving smaller payment increases from Medicare, according to Theresa M. Forster, a vice president of the National Association for Home Care & Hospice.

“Hospices have been experiencing a financial tightening,” she told Kaiser Health News recently, “and it makes things less stable.”

This article was produced by Kaiser Health News with support from .

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San Diego Hospice Files For Bankruptcy

Randy Dotinga — Thu, 07 Feb 2013 16:47:00 +0000

SAN DIEGO — Hobbled by a federal investigation into its practice of treating patients who had more than six months left to live, one of the biggest hospices in the country has filed for bankruptcy as it tries to continue operating. A local hospital chain is heeding San Diego Hospice’s plea for help, however, and promising to provide services for as many patients as need it.

The financial woes facing San Diego Hospice, which has slashed its workforce and patient load, might not be isolated. Hospices nationwide are under intense scrutiny from Medicare, and facing lower growth in their reimbursement levels. “There’s a bit of a squeeze going on. Hospices have to do more with less, and you can see how that could take its toll over time,” said Theresa M. Forster, vice president for hospice policy and programs at the National Association for Home Care & Hospice, a trade group.

San Diego Hospice main campus

As Kaiser Health News reported last month, federal officials have made a priority of investigating hospices and their Medicare reimbursement claims for patients. San Diego Hospice, which normally treats as many as 1,000 patients at a time, came under scrutiny because it didn’t properly document that doctors believed patients had six months or less to live, as required by the Medicare program. In some cases, patients lingered for years while the federal government continued to pay for their care.

The hospice has laid off hundreds of workers, and its patient load has fallen to about 600 because of more stringent rule compliance and bad publicity. This week, facing the prospect of being forced to return reimbursements, the hospice announced that it has filed for Chapter 11 bankruptcy protection and hopes to remain open.

“The outcome of this process is uncertain,” its , so it turned to a hospital chain for help.

Scripps Health, which serves 500,000 patients annually and has five hospital campuses and 23 clinics, is stepping in. It bought a small local hospice this week, allowing it to avoid lengthy red tape to get licensing, and is ready to offer hospice care to whomever needs it, said Chris Van Gorder, the chain’s president and CEO.

He expects more hospitals to take over hospice services as stand-alone hospices face more financial challenges. “I think we will see more small agencies get into trouble,” he said.

In the big picture, the federal attention to hospices is costing hospices more even if they are following Medicare rules because they must devote resources to guarantee that they are complying with regulations, said Forster of the National Association for Home Care & Hospice. And as of the 2012-2013 fiscal year, hospices aren’t getting their usual annual 2.5 percent to 3 percent increase in reimbursements but are instead getting 0.9 percent, she said.��

“Hospices have been experiencing a financial tightening,” she said, “and it makes things less stable.”

J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization, isn’t so sure that a crisis is at hand. He said the troubles at San Diego Hospice seem to be isolated: “I haven’t heard of any hospices that are involved in anything like this that is so difficult and so sad.”

He did, however, say that he is not aware of any larger hospice that has gone bankrupt.

This article was produced by Kaiser Health News with support from .

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Slowly Dying Patients, An Audit And A Hospice’s Undoing

Randy Dotinga — Wed, 16 Jan 2013 06:06:00 +0000

SAN DIEGO — Death sometimes came slowly at one of the nation’s largest and most respected hospices. That’s not unusual. But here’s a twist: For some patients, it came not at all.

While hospices normally treat patients with fewer than six months to live, San Diego Hospice often served people who had much more time left.��

Kathleen Pacurar is president and CEO of San Diego Hospice and the Institute for Palliative Medicine.��A federal audit of its admitting practices has forced the hospice to��cut 260 workers and discharge 100 patients who aren’t considered to be within six months of death.��(Photo by Sam Hodgson/For KHN).

Not anymore. In the wake of an ongoing federal audit and an internal investigation, the nonprofit hospice’s patient load has dropped by hundreds as it targets its services more tightly to only those within the six-month window.

The resulting cash crunch forced it to cut 260 workers and close a 24-bed hospital this month.

Across the country, hospices with generous admissions policies may find themselves on life support too. Medicare, which heavily funds hospice programs, is cracking down on the industry’s growing habit of embracing those whose deaths aren’t imminent.

It’s not clear how many hospice programs are being investigated. But there’s definitely an increased level of scrutiny, said J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization.

Indeed, the Health and Human Services Office of the Inspector General has, in recent years, made such investigations a priority. In 2012, for instance, the agency’s�� included an ongoing review and assessment of the “appropriateness of hospices’ general inpatient care claims.” In addition, the�� emphasizes the need to examine the relationships between hospices and nursing homes: “OIG found that 82 percent of hospice claims for beneficiaries in nursing facilities did not meet Medicare coverage requirements.”

“We’re facing a time of much more extraordinary focus on guidelines and regulations,” said Kathleen Pacurar, president and CEO of San Diego Hospice, who’s had to cut her staff by about 30 percent.

Why this spotlight on hospice? Because it’s a booming business, a $14 billion industry that served an estimated 1.65 million people in the United States in 2011. That’s about 45 percent of all those who died that year, the hospice association estimates.

Medicare paid for the hospice benefits of of those patients. When used��properly��to provide dying patients with palliative care��instead of continuing futile medical treatments, hospice care can��save the government money, research has��shown.

At San Diego Hospice, the trouble began when federal officials launched an audit of 2009-2010 admissions that’s still ongoing. An internal investigation at the hospice revealed that it didn’t always properly document that patients had six or fewer months to live, according to Pacurar.

The federal audit led Medicare to temporarily suspend reimbursements to the hospice in November; the hospice briefly stopped taking new patients.

In a statement responding to questions about the San Diego case, the Centers for Medicare & Medicaid Services said: “We take seriously our responsibility to safeguard taxpayer dollars from fraud and abuse. We are working with this facility to ensure that the immediate needs of patients are being met, while actively monitoring billing to prevent abuse or fraud.”

Overall, San Diego Hospice’s patient load has dropped from 1,000 to about 600, although Pacurar said it continues to accept all eligible patients. She said the numbers have dropped for multiple reasons: the hospice admits fewer patients due to tighter criteria, it has discharged about 100 patients who aren’t considered to be within six months of death and it’s getting fewer new patients due to bad publicity.

Things may get worse. In its statement, CMS added that any overpayments must be reimbursed to Medicare.��Pacurar said she thinks the government won’t go as far as to actually cripple the hospice,��but��there’s no way to know.

Patient load at Pacurar’s San Diego Hospice has dropped from 1,000 to about 600, a result of a federal audit and��tighter admitting criteria��(Photo by Sam Hodgson/For KHN).

“That’s the hard part about what our organization is going through,” she said. “We’re one of the first to go through such an extensive audit, and there’s the unknown of what they’re looking for.”

How did this mess happen? The big problem appears to be the hospice’s tendency to not kick out patients when they lived longer than six months.

“I was talking to my staff the other day, and I said to look at the percentages of patients who are here over six months,” Pacurar said. “One of my staff members said, ‘I think it’s a really amazing thing when we have patients who stay for a long time because it demonstrates that whatever we’re doing, it’s prolonging their lives.'”

And therein lies the rub. If patients recover, Medicare expects them to leave the hospice program. Patients can stay in a federally funded hospice program for more than six months, but only if they’re re-certified as still likely to die within six months.

“It’s a catch-22: Oftentimes these patients have extended prognoses because we’ve been in there working with them,” Pacurar said.

In 2011, for instance, 475 out of the San Diego Hospice’s 3,700 patients — 12.8 percent — stayed for longer than 180 days, according to . The hospice said these figures appeared to be correct.��

Another wrinkle: Medicare pays a set amount each day a patient is in hospice, ranging from $153 for routine care to $896 for around-the-clock assistance. Even with the varied pay levels, it’s hard for hospices to make money during the time-intensive periods when patients are first enrolled and in the final weeks and days of their lives. Instead profits usually come during the intervening periods when the patients require less attention. That creates an incentive for hospices to keep serving patients as long as possible, even for years.��

“The longer a patient stays, generally speaking, the better the hospice is able to deal with those costs and probably has a greater opportunity for a higher financial margin on that patient,” said Theresa M. Forster, vice president for hospice policy and programs at the National Association for Home Care & Hospice, a national trade association for home care agencies, hospices and home care aide organizations.

Pacurar said San Diego Hospice didn’t have financial benefits in mind when it allowed patients — including those treated at home — to continue receiving services even if they weren’t expected to die soon.

To make things more complicated, the evolution of hospice care has made it more difficult to estimate how much longer hospice patients have to live.

When the hospice movement began about 40 years ago, it focused on cancer patients, whose remaining months of life would often be fairly clear. Now, the hospice movement embraces a wider range of people considered to be terminally ill, including those with conditions like heart disease and Alzheimer’s disease. Overall, it’s harder to predict when those patients will die compared to those with cancer.

“That’s where it’s started to get more gray,” Pacurar said. “The industry became much broader in the patients we took on and therefore the prognosis became more challenging.”

Another twist: It’s no secret to hospices that certain kinds of patients are more expensive to treat (such as those with cancer) and others are cheaper to treat (those with Alzheimer’s and those in nursing homes).

In fact, a 2011 Journal of the American Medical Association found that for-profit hospices were more likely than their nonprofit counterparts to find ways to avoid enrolling more expensive patients. “[T]hose hospices serving the neediest patients may face difficult financial obstacles to providing appropriate care in this fixed per-diem payment system,” the study said.

Another , this one published in , reports that many hospices refuse to accept patients who require expensive types of treatments, such as chemotherapy (which can be used to lower pain levels), intravenous feeding and blood transfusions.��

Hospices are under federal scrutiny for more than their choice of patients.

In 2011, Bloomberg News that the growth in hospice has been fueled by enrollment bonuses to employees and kickbacks to nursing homes that refer patients. Investigators alleged that this led hospices to accept patients who weren’t eligible for the service.

While Medicare is focusing on the problem of patients who linger in hospice, Schumacher of the National Hospice and Palliative Care Organization pointed out that a third of patients only receive hospice care in the last week of their lives. “That’s one of my greater concerns,” he said. “They don’t receive the full benefit of hospice services.”

Pacurar, of San Diego Hospice, said another group of patients needs more attention: those who are dying but aren’t within that six-month window that makes them eligible for hospice care – in other words, the patients that her hospice used to be willing to treat.

Her hospice will no longer be treating them, at least until they’re closer to death. They will remain under the care of their regular physicians.

“What do you do with patients who maybe aren’t dying tomorrow, but have got a whole year or two where they need a higher level of care?” she asked. “You’re seeing healthcare try to figure out that gap.”��

This article was produced by Kaiser Health News with support from .

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Taking A Risk To Secure Health Insurance

Randy Dotinga — Tue, 12 Jun 2012 19:11:00 +0000

When it comes to medicine, I usually do as I’m told.

Take a pill? Sure. Blood test? Absolutely. Surgery? If you think so, doc.

But I’ve been acting against medical advice since January, and I’ll keep on ignoring it until July. Let me explain.

Last January, I cancelled my existing, very expensive individual coverage through California’s state-run��and became insurance-free to gain eligibility for the��.

Randy Dotinga

That means that if I get a cancer diagnosis tomorrow, I’ll end up with huge medical bills. I did this because I want to take advantage of the federal government’s efforts to help people like me who have pre-existing conditions and no access to a group plan.

Those two words — pre-existing condition — explain why I find myself in this circumstance.

Back in 1996, when I was 27, my heart started to beat funny. The diagnosis was lone atrial fibrillation, a kind of irregular heartbeat that appeared for no apparent reason and, in my case, couldn’t be fixed. Even getting “cardioverted” didn’t help.

A daily beta blocker keeps my heart from pumping too fast, and my risk of any complications is low. Even so, no one will insure me on the individual market.

And since I’m single and self-employed as a freelance writer, I don’t have access to guaranteed group coverage, except for a plan for artists and writers that would cost me at least $31,226 a year.

That’s why, for the last few years, I have made do with the state’s high-risk insurance plan. California, where I live, is one of 35 states that offer health insurance to people with pre-existing conditions who otherwise wouldn’t be able to get individual coverage.

But for me, access to California’s high-risk plan is expensive — the PPO plan would cost me $748 a month this year, close to $9,000 a year — and the coverage is thin. The annual spending limit is just $75,000, hardly enough to cover a major health crisis. And the lifetime benefit limit is a paltry $750,000.

As a result of the 2010 federal health law, I now have another possibility: The federal high-risk plan would cost me just $265 a month — $3,180 a year — and offers unlimited annual and lifetime benefits.

That sounds like a great deal cost-wise, and the lack of coverage limits is much better for me in the long run if I get diagnosed with an expensive disease. But there’s a rub: I’m not eligible for the federal plan unless I go six months without any coverage at all. That’s just what I decided to do. To me, the prospect of affordable and unlimited coverage — at least from July 2012-December 2013 — is worth the risk of going without coverage for the allotted time.

“You’re responding in an understandable way,” said Harold Pollack, a University of Chicago professor who studies health care. “Any program that requires people to be actively uninsured creates a very paradoxical and painful set of incentives and encourages people to do what you’re doing.”

But I’m taking a major risk by going without insurance for so long. This would be the absolute wrong time to get hit by the proverbial bus. Or, as happened a few weeks ago, hear a dermatologist ask “Have you had that looked at?” while I lounge at a hotel pool. (Don’t worry. I’d previously had it looked at, and it’s nothing to worry about.)

My decision to go coverage-free did not go over well up in Sacramento when I mentioned it to staffers at the California Managed Risk Medical Insurance Board, which oversees the state and federal high-risk plans here.

A spokeswoman told me that the agency wouldn’t cooperate with me on this story if I planned to embolden other people to make the same decision. Janette Casillas, the agency’s executive director, put it this way: going without insurance in order to get insurance “is not something that we would encourage.”

The federal government could change everything by getting rid of that six-months-without-coverage rule. But if it did, it would need to find another way to limit coverage for high-risk patients so it doesn’t cost more than the budgeted amount, Pollack said. “They’d have to have some other rationing requirement that would also create problems, since it’s such a small program for such a huge need,” he said. “Almost every deficit of this program comes down to the fact that Congress has not appropriated enough money to meet the need that is there.”

Even if I do land in the federal high-risk plan as of July 1 — if space is available — it’s not a long-term fix for me or anyone else. The good news, for me at least: In 2014, the federal health law is scheduled to take full effect, including provisions that protect consumers who have pre-existing conditions from being denied coverage. The high-risk pool coverage won’t be needed anymore.

But what if the Supreme Court nixes health care reform? What happens next? Is it possible that funding for the federal program might disappear before 2014?

Sandy Praeger, commissioner of the Kansas Insurance Department, thinks funding for the federal high-risk pools will vanish if the Supreme Court entirely overturns health care reform.

In Kansas, she said, the federal high-risk plan serves about 400 people, some of whom are quite ill. But it’s pricey. For each $1 in premiums in Kansas, she said, the program pays out $10 in claims.

For now, state insurance officials nationwide are making contingency plans for what they’ll do if the federal high-risk plan disappears, said Amie Goldman, who oversees Wisconsin’s high-risk plans.

In Wisconsin, she said, officials have already decided that residents who lose the federal coverage will be able to join the state high-risk plan and retain continuous coverage. “We wanted to be ready because we know people are going to call immediately and be very concerned,” she said. “We have a lot of people who are relying on this coverage for sometimes-lifesaving treatments. We have nine people in our [federal plan] who have been approved and are on waiting lists for transplants.”

Ultimately, she said, the future of the high-risk programs in Wisconsin will depend on the Supreme Court opinion and, if necessary, on legal analysis regarding the breaking of insurance-related contracts that are already in place.

Here in California, my health insurance future is uncertain. Even if I join the federal high-risk plan, it may disappear before 2014, along with health law itself. If that happens, I may have no choice but to go back to paying about $9,000 a year for California’s paltry high-risk plan.

There’s one tiny bit of good news. A state legislator is pushing a bill that would eliminate the annual and lifetime benefits from California’s high-risk plan, which is known by the adorable term “Mister MIP.” (That stands for MRMIP, or Major Risk Medical Insurance Program). The bill’s chances may not be adorable. It would require more state spending, after all.

For now, I’m just hoping nothing goes wrong until I get insurance again.

Randy Dotinga is a freelance writer based in San Diego.

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