I know it's hard to believe, but the estimates aren't matching reality:
Colorado's troubled high-risk health-insurance pool has asked the federal government for nearly $15 million more than planned after running up early claims that are twice the national average.
High-risk, uninsurable patients were the heart of emotional pleas for national health-care reform in 2010, and Colorado got $90 million of a $5 billion federal pool to help them.
The allocation was meant to last until 2014, when insurers have to cover everyone regardless of condition.
But extremely high costs from the "sickest of the sick" forced Colorado to spend $22,500 per patient in the first year of the program, U.S. records show. The state has paid out $21.7 million in claims for 964 members of the pool.
Quarterly reports from other states show average spending nationwide at about $11,500 per patient in the pools run by state governments. (The U.S. Health and Human Services Department runs pools for 23 states that chose not to set them up.)
Programs similar in size to Colorado's, such as Wisconsin's and Oregon's, spent from $4,400 to $15,640 on each patient.
It's not just Colorado that is having trouble making the budget face reality:
Eight other states have joined Colorado so far in seeking supplements to their original budget, said Steve Larsen, who oversees the high-risk pools for the federal Center for Consumer Information and Insurance Oversight, part of HHS.
The really bad news? It's going to get worse before it gets better:
In previous interviews, Rocky Mountain Health Plans has said Colorado high-risk patients require expensive hospital stays at three times the rate initially projected.
Now, the health plan will say only that the pool has "significantly higher medical needs" than the general population or a separate state risk pool.
"The budget continues to be an area that warrants close attention," said Kayla Arnesen, a spokeswoman for Rocky Mountain Health Plans.
Administration costs are limited to 10 percent of the money over the life of the three-year budget, and states are staying within that, Larsen said. An analysis of the 23 states whose pools are run by the federal agency showed 27 percent of claims were coming from extremely high-cost cancer patients, he added.
The federal pool in Colorado has 1,087 enrollees, with an expected cap of about 4,000.
We are currently at about 25% of the intended pool, and the State has a shortfall of about $15 million, with claims running at 2x the National average. At what point does one of the States that is below the average cost, with no budget issues call Colorado out?
Just wait until this happens to a State with a much larger population base. The shit will be hitting the fan very quickly.
