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Waiting For Mr. Mib: Uninsured Woman Hopes ObamaCare Comes Through In California

First Posted: 10/21/10 02:08 PM ET Updated: 05/25/11 07:05 PM ET

Hospital

Three-time breast cancer survivor Mary Duffy volunteered for Barack Obama's presidential campaign because of his promise to reform the health care industry, and she kept her fingers crossed as Congress battled over what reform would look like.

She was disappointed that the legislation didn't call for a public health insurance option, but she was somewhat optimistic that another provision might help her. The law gave the Department of Health and Human Services 90 days to set up a "high risk pool" to provide insurance to people excluded from the private insurance market due to pre-existing conditions -- people like her.

Now she's hoping the California Managed Risk Medical Insurance Board will hurry up and provide the coverage she applied for this summer.

"I'm waiting for Mr. Mib," said Duffy, using the term she hears from the MRMIB's staff when she calls to ask when she can expect coverage. "They cashed my check in August."

The Pre-Existing Condition Insurance Plan has had a slow start. The federal government runs the PCIP in 22 states, and state governments (like California's) handle it in the rest. As of early August -- the last time HHS provided an update on enrollment -- only a few thousand people had applied for coverage. According to HHS, California is the only state left that hasn't started offering coverage.

Duffy, 61, told HuffPost she coughed up the $802 even though she thought it was not an affordable monthly premium (PCIP payments vary depending on an applicant's age). She initially expected coverage to be available at the beginning of August, but that deadline passed without a chance to apply. Once she applied, she expected coverage at the beginning of September. Then the MRMIB's website said it would be ready by Oct. 7. Now it says simply that "the expected start of PCIP coverage has been delayed."

Duffy, who lives in Redwood City, Calif., said she's become especially anxious because on Thursday she is going to the doctor for a biopsy. She is afraid that she may have cancer again. Without health insurance, she said, "If it turns out I need surgery, I think I'm going to wait."

The MRMIB told HuffPost that coverage will be available "any day now." The board is finalizing its contracts with the companies that will administer the program.

"The amount of time it's taken us to bring this plan up has been extraordinarily quick," said MRMIB spokeswoman Jeanie Esajian. "Initially, we thought we'd just duplicate the state high risk pool, but that wasn't to be, because the vendors we had for the state high-risk pool didn't want to participate."

An additional hurdle to launching the PCIP in California was the requirement that the state legislature pass legislation allowing it.

Esajian said the MRMIB has mailed out 6,200 PCIP info packets and received 737 applications. As soon as the contracts are finalized, approved applicants will receive "welcome calls."

"We are confident that these final issues will be resolved within days and Californians living with pre-existing medical conditions like cancer, diabetes, and other life-threatening conditions will be covered," said HHS spokeswoman Jessica Santillo in an email to HuffPost.

Before health care reform, 35 states ran their own high-risk pools, reaching about 200,000 people. (Those pools will continue to operate alongside the PCIP.) Expanding high-risk pools is a centerpiece of Republicans' alternate health care reform proposal, and the PCIP is based on the GOP vision. The program is supposed to last until 2014, when people should be able to choose from affordable policies available on an "exchange."

Even though it's much more generous and also more affordable than existing state pools, the PCIP's premiums remain an obstacle to enrollment, as does the requirement that applicants be uninsured for six months to be eligible. HHS officials expect the program to reach only 350,000 people. With unlimited funding, the Congressional Budget Office estimated that it might cover 700,000 people. There are roughly four million uninsured due to pre-existing conditions.

Duffy recently re-launched her own business doing food service consulting for colleges and universities after losing her job in 2008. She was able to continue her insurance coverage under COBRA until December. She was disappointed that Congress dropped a proposal that would have allowed her to keep COBRA until 2014. (HuffPost has chronicled her quest for health insurance for the past year.)

Duffy likes to say she's got "high bounce," and she maintains a positive attitude even though she's deeply concerned about the biopsy. She doesn't want to know how much it's going to cost. "I have decided to not ask because there's nothing I can do about it."

UPDATE 10/26/2010: The California government announced this week that its PCIP is open for business, and Mary Duffy told HuffPost that she does not have cancer. HuffPost will follow up on whether she successfully gets coverage from the program.

UPDATE 10/28/2010: Duffy told HuffPost that she is now insured by the PCIP.

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