Federal insurance plan no cure-all for some valley residents

Excitement washed over Bryan de Simas when he heard Wednesday that the government guarantees health insurance to those with pre-existing problems such as him.

Finally an answer for the unemployed Las Vegas resident who has been relying on temporary coverage from his previous employer, which soon runs out.

He grew even more ecstatic when discovering the federal government is reducing Nevadans rates by 38 percent in July.

The 53-year-old's monthly premium would be $260, almost half of his current rates, meaning insurance wouldn't bleed him dry before finding a job.

But the elation was short-lived.

He's not eligible for the Pre-Existing Condition Insurance Plan. To qualify, he must be without insurance for six straight months.

The insurance program, started last summer as part of the health care reform signed into law by President Barack Obama, offers relatively affordable coverage for those denied by the private sector because of pre-existing conditions.

The program is meant to fill the gap until 2014, when it becomes illegal for insurers to discriminate against those for their medical histories.

Officials initially predicted it would insure hundreds of thousands, yet only 147 Nevadans and 18,000 Americans have signed up for the program. To boost enrollment, the Department of Health and Human Services is dropping premiums in 17 of the states where it runs the program, said spokesman Bennett Blodgett. State-run programs are encouraged to do the same.

Price drop or not, those like Simas are reaching for the government insurance but hit their hands on an unnoticed pane of glass, the six-month stipulation.

Simas has opted to walk away instead of punching through the glass, fearful he'll be cut on his way through. For someone with health problems, it's too risky to be uninsured for half a year, he said.

"You got to pray nothing happens for six months," said Simas, who has diabetes, high blood pressure and high cholesterol -- and was hospitalized less than two months ago.

Gary Cannon also has decided the risk isn't worth the reward, especially after a $154,000, three-day hospital stay.

"That will change your life," said the barber and heart-attack survivor with two stents (tiny tubes placed in arteries to keep them open) in his heart.

Blodgett said the department has heard similar complaints but can't do anything about it. Congress put the six-month stipulation in the health care reform law.

"The statute is very specific," he said.

Congress included the rule to make sure the program is available only to those who cannot receive coverage, Blodgett said. However, the health department has changed another rule where it has more leeway. It no longer requires applicants to show rejection letters from insurance companies. A doctor's note describing their pre-existing condition will suffice.

"Those of us who are responsible enough to pay for insurance are being penalized," said 55-year-old Debbie Seibert.

She retired early with her husband, whose early-retirement insurance was recently cut. She now pays $1,113 a month through a state program because every major insurance company rejected her, claiming she's too risky because of her stent.

"Premiums are wiping us out," Seibert said. "It's killing us."

But she won't willingly be uninsured for six months.

"It's a sad situation," she said.

Contact reporter Trevon Milliard at tmilliard @reviewjournal.com or 702-383-0279.