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Health Plan Aims to Help Uninsured

Oct. 21, 2005 – Lawmakers met this week with a research and planning team working on a proposal to cut the number of Virgin Islanders with no health insurance coverage in half over the next few years. Both the Senate president and the Senate minority leader said the plan holds promise for relieving the territory's hospital system of unpaid hospital bills caused by uninsured patients.
The plan is the result of a three-year effort to find ways of making health insurance in the Virgin Islands more affordable. Representatives from the Bureau of Economic Research, with help from the Office of the Governor and the University of the Virgin Islands, carried out the study and are working on the development of an affordable insurance policy. The study was funded with a $1 million grant from the U.S. Department of Health and Human Services.
(See"Study Funded to Document V.I. Uninsured".)
According to Lauritz Mills, Economic Research director and lead investigator, policy makers want to cut the number of uninsured residents from 24.1 percent to 13 percent by the end of 2006.
"The Virgin Islands government realizes that the hospitals will never become self-sufficient if we do not have more individuals covered by health insurance, and the individuals we are trying to reach are those in the private sector," said Senate President Lorraine Berry.
Berry, along with Senate Minority Leader Roosevelt David and freshman lawmaker Pedro "Pete" Encarnacion met with Mills and others who had worked on the three-year study and the emerging plan.
Jacqueline Hoop-Sinicrope, Ph.D, was hired by Economic Research to serve as project manager. Hoop-Sinicrope said Friday that she hoped to open the program for enrollment by Jan. 1, depending on how fast the Legislature acts on the suggestions. However, an insurance provider has not been chosen yet, she said.
Out of seven who were a approached with a request for proposal, the field has been narrowed to two companies. Hoop-Sinicrope said she expected the contract to be awarded next week. She said the seven companies had been pre-selected from a group of national qualifying companies.
After the Monday meeting with senators at the Palms Court Harborview Hotel, Hoop-Sinicrope said she felt the plan had gotten a favorable reception.
"We were briefing the senators and some of their staff members about the particulars of the plan. One of the main issues in the territory is that the hospitals and the health centers lose a lot of money because there are people they give service to who have no health insurance,"
Hoop-Sinicrope said.
She described the plan as being aimed at enrolling private sector workers, most of whom work for small businesses with 10 or fewer people on the payroll. This group is the best one to get the program started, Sinicrope said, because whether they are business owners, self-employed, working on contract or on the payroll, they are all making money and can afford to pay some kind of premium.
The group can be as small as one person, Hoop-Sinicrope said.
She said premiums for adults would be in the range of $150 to $160 a month, with up to three dependent children costing $60 each per month. There would be no additional charge for more than three children, she said. The deductibles would be $250 per individual or $750 per family. The benefits would extend to off-island health care providers, but the share of the costs the insurance company would pay would be reduced.
The plan also carries a $1 million life-time cap per beneficiary on all services, Hoop-Sinicrope said.
By grouping business together into a multiple employer trust, the health insurance planners hope to create a large enough pool of policy holders to be viable to an insurance provider. The plan hinges on the V.I. government kicking in $10 million to, among other things, set up a premium assistance program that would allow low- and some moderate-income private sector workers to enroll in the plan.
"What we recognize is even if you have affordable health insurance premiums you still are going to have workers who are at the lower end of the wage scale who still may not be able to afford the program, so one of the details that we are completing is the development of a premium assistance program," Hoop-Sinicrope said.
She said she hopes the program will be marketed through agents who are already selling group health insurance policies. The insurance would be treated like any other group policy. Meetings would be set up with the brokers to iron out the details of what the costs and commissions would be to the brokers, and how the program would be administrated, she said.
"There is a great need for this and I think the plan is well-intentioned," said Steve Baker of Steve Magras and Associates Inc., one of the territory's approximately five or six major health insurance brokers.
Baker said he plans to be involved, but, "The devil is in the details," he said.
With 45 million uninsured Americans, Baker said something needs to be done.
Baker said the V.I. has a disproportionately high number of uninsured for a number of reasons.
"A plan like this will fill the gap," he said.
As of 2004, 14 U.S. states had adopted premium assistance programs, according to the Maine-based National Academy for State Health Policy. Those programs use public funds to bridge the financial gap between what employers can pay to provide health insurance and what some workers can afford to pay in premiums.
Sen. David said a preliminary bill has been drafted by the Senate legal counsel.
"We are waiting for additional information. The administration is going to have its input, and a number of other senators. Once it gets to the committee of jurisdiction, which is the Health Committee, I'm sure the public is going to have its input as well," he said.
Hoop-Sinicrope said plans are in the works to make presentations throughout the community to bring the public up to speed on the details of the plan.
The total appropriation request, as it currently stands, calls for $10 million for the first year to put the program in place; $2 million for pre-existing condition claims; $2 million to the insurance premium guarantee fund and $6 million for the premium assistance program.
Hoop-Sinicrope said she expects that if the plan goes through, it will let area hospitals cut their budget requests to the government because they won't need as much money to cover uncompensated care.

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