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Utah's Uninsured

"Pre-existing conditions can make it scary to change jobs."
Cannot Afford Utah's HIP

Like most Utahns, Terri is a hard worker. She raised six children while holding down a job as a mortgage broker. However, also like most of us, life has not been entirely smooth and predictable for her.

Two recent events have changed Terri’s ability to get health insurance. First, two of her children died tragically
in a car accident. As a result, Terri has been battling depression. With medical help, she has been able to overcome this horrible event and continue to work and live her life.

Second, Terri recently changed jobs. Unfortunately, her new employer does not offer health care coverage. Because of Terri’s depression and a heart murmur, she has been repeatedly denied health insurance on the individual market.

Terri cannot afford the state’s high risk pool, HIPUtah. “Unless we fix our health care system, I don’t believe I will have health insurance until I qualify for Medicare. That’s a long time to wait.”

The Patient Protection and Affordable Care Act will help Terri and her family in a variety of ways:

  • In June 2010, an interim high-risk pool will provide immediate access to insurance for Utahns who for at least 6 months have not been able to get coverage because of a pre-existing condition. This pool will operate until 2014 when the full health reforms come online.
  • Lower income Utahns will be eligible for subsidies to help them purchase coverage through the high-risk pool.  This interim high-risk pool has consumer protections to ensure you get quality insurance.  The plan must cover at least 65% of a patient care costs and cap out of pocket charges at $5,950 a year for an individual or for a family, $11,900.  The plan cannot exclude coverage of pre-existing conditions or charge older Utahns more than younger people.
  • Starting September 2010, insurers cannot discriminate against children based on pre-existing conditions.
  • In 2014, insurers cannot discriminate against anyone based on pre-existing conditions.

  • Individuals and families will be able to shop for and compare affordable plans on a new online marketplace called an Exchange.
  • Families may receive subsidies to help buy coverage from their state’s health insurance exchange.  Based on income, there will be a cap to the amount charged for premiums and out-of-pocket expenses will also be capped.
  • If they still cannot afford to buy insurance, they could apply for a hardship waiver and subsidies will be provided to families with incomes of up to 400 percent of the poverty level