Executive Director’s Report March 5, 2009

Administration

• Medco Contract Update The latest draft of the agreement memorializing the agreement effective July 1, 2008 was received from Medco on Monday, March 2, 2009. There are still a few outstanding issues, however we are getting close to a final agreement. • Medco Payment Error Medco has informed us that their Medicare Prescription Drug Plan (PDP) has issued refunds to WSHIP SPAP enrollees that should have been paid to WSHIP since WSHIP is the secondary payor. We are cooperating with them to try to recover these monies from WSHIP enrollees. Medco is working on a plan for recovery and to make WSHIP whole. The total amount involved is about $113,000.

Federal Government

• High Risk Pool Grant Funding As of February 25, 2009 the US House of Representatives was considering H.R. 1105, the Consolidated Appropriations Bill for FY2009. The legislation contains full funding for the State High Risk Pool Grants program of $75 million for FY2009 (October 1, 2008 – September 30, 2009). Both the House and Senate are expected to pass H.R. 1105. This should result in WSHIP receiving a grant similar to what was received in 2006 (approximately $2.3 million). • Medicare Advantage Plan Funding The Obama budget would reduce excess funding for Medicare Advantage Plans from 114% of standard Medicare to 107% for 2010. This may result in some carriers currently offering Advantage plans in Washington state to withdraw. However, it is likely that most, if not all, of the HMO and PPO plans will continue in 2010.

Washington State Government

Legislature

• Fulfillment of requirement in the Blue Ribbon Commission bill to study broadening funding for WSHIP The final report was issued to the Legislature on February 11, 2009. It can be viewed at http://www.ofm.wa.gov/healthcare/healthin/options/2008/final.pdf

Office of the Insurance Commissioner

• Financial Audit The draft report to the Office of the Insurance Commissioner, in response to the final report that was issued on January 8, 2009 and distributed to the Board on January 28, 2009 is appended to this report. By your approval of the consent agenda you will be approving it as well. If you would like to discuss the report, please follow the usual procedure to remove it from the consent agenda.

NASCHIP Activities

• Public Relations Document NASCHIP released its educational paper to the health committees of Congress and the press on January 12, 2009. The paper is attached.

Miscellaneous

• WAHU Annual Conference Anne Mackie and I attended the Washington Association of Health Underwriters annual meeting in Seattle on March 4, 2009. Anne staffed the WSHIP display in the exhibit hall, while I spoke to the group on the importance of WSHIP to the individual market, the Standard Health Questionnaire and WSHIP benefit plans. Anne traveled to Spokane that evening and staffed the display as well as giving the same talk to the Spokane meeting.

2009 Board Schedule and Work Plan

• Seek Out Grant Sponsorship for Funding Study I am working with Cindy Watts, of the University of Washington Department of Health Services, to identify sources and solicit grant funds for the study included in SB5777 and SB1713. She believes it is an excellent health policy study and has agreed to supervise the conduct of the study. I expect to receive a draft budget from University staff which I will use in approaching foundations.

Page 2 of 2 Kären Larson, Executive Director P. O. Box 329 Bow, Washington 98232-0329 360/766-6336, fax 360/766-5287 [email protected]

March 13, 2009

James T. Odiorne, CPA, JD Deputy Insurance Commissioner Company Supervision Division PO Box 40255 5000 Capitol Blvd. Tumwater, WA 98501

Re: Financial Examination of Washington State Health Insurance Pool

Dear Mr. Odiorne:

The Washington State Health Insurance Pool (WSHIP) is in receipt of the Findings, Conclusions, and Order Adopting Report of The Financial Examination of the Washington State Health Insurance Pool as of December 31, 2007 issued January 8, 2009. On behalf of the WSHIP Board of Directors, I want to confirm that we value the opportunity provided by this examination to improve the accuracy and integrity of financial information we keep and report.

Please find below responses to the orders in the report. The report order is shown in italics, followed by WSHIP’s response.

1. It is ordered that WSHIP consider recording premiums on the due date. Comments and Recommendations 1, Examination Report, page 1.

Response: WSHIP accepts the recommendation of recording premiums on the due date, and will implement this change effective in the 2008 financial statements and in all financial reporting thereafter.

2. It is ordered that, if access to the datacenter is required by individuals other than IS personnel, WSHIP consider having individuals sign in, using an entry log, and be escorted by someone from the IS department. Comments and Recommendations 2, Examination Report, page 2.

WSHIP Financial Examination Page 2 of 2

Response: Datacenter access will be limited exclusively to IS personnel. Access is not required by individuals other than IS personnel.

Thank you for the opportunity to provide WSHIP’s detailed report specifying how the company has addressed each of the requirements of the order.

Sincerely,

Kären J. Larson Executive Director

CC: Vernon E. Stoner, Chief Deputy Insurance Commissioner Patrick H. McNaughton, Chief Examiner HOW STATE HEALTH INSURANCE POOLS ARE HELPING AMERICANS An Important Safety Net for Persons with Chronic Medical Conditions

BY LYNN R. GRUBER guaranteed issue and community rating. This article President, Minnesota Comprehensive Health Association examines what a high risk insurance pool is, which states Chair, NASCHIP Communications Committee have them, and the role they play in the insurance market. The article also offers facts to debunk some January 6, 2009 myths surrounding high risk insurance pools.

UNSUSTAINABLE HEALTH CARE SYSTEM CHANGE IS COMING TO THE AMERICAN HEALTH CARE SYSTEM America’s current health care system is a ticking time bomb. The skyrocketing costs of health care for The harsh reality that confronts the new Presidential Americans who are uninsured, underinsured, or paying Administration and Congress this January is that ever increasing insurance premiums place a huge significant change is needed in our health care system. economic and psychological burden on struggling It is important that legislators, their staffs and the public families. understand the function high risk insurance pools play in the current system and what role, if any, they might have In mid 2008, The Denver Post reported that health as America looks to improve its health care system. insurance costs for employer sponsored health plans might rise 10.6 percent in the coming 12 months. That is WHAT ARE HIGH RISK INSURANCE POOLS? the smallest increase since at least 2001, but also more than double the rate of inflation, according to a survey by While most health care policy experts have some Aon Consulting Worldwide Inc. The expected cost understanding of high risk insurance pools, many increase for employer health misconceptions remain. coverage reflects the rising price of “Adequately funded high-risk Understanding exactly what high services and increased utilization risk insurance pools are and the by an aging population. insurance pools can provide affordable coverage for persons role the play in the health care system is essential if we are going to As the population ages and with serious, chronic conditions examine their role as part of any employer coverage dwindles, those or with acute illnesses of shorter health care reform proposal. numbers and the percentage of duration more effectively and at GDP spent on health care may lower costs than do requirements High risk insurance pools are continue to escalate until the for guaranteed issue and health insurance plans created by system is no longer sustainable. As state legislatures as non-profit it stands, healthcare spending community rating.” organization or state/governmental makes up about 16 percent of the – Lanny Craft, Chair, NASCHIP agencies with their own benefit U.S. economy, or $2.2 trillion a – plans, premium rates, year. These numbers are only administration, and management. going to rise, forces many These high risk insurance pools are commonly called employers to limit or drop coverage and add many to the health insurance associations or comprehensive health categories of un-insured or under insured. insurance associations. State law dictates eligibility rules, ranges for premium rates, and funding mechanisms to Enter High Risk Insurance Pools. These pools play a cover expenses not paid for by premium revenue. crucial role for many Americans. They can make the Funding mechanisms include assessments on health difference between coverage and no coverage, treatment insurers and state appropriations from a state’s general or no treatment and even life and death. Organizations fund. such as the National Association of State Comprehensive Health Insurance Plans (NASCHIP) believe that Typically, three groups of people are eligible for high risk adequately funded high risk insurance pools can provide insurance pool coverage: affordable coverage for persons with serious, chronic conditions or with short-term acute illnesses more effectively and at a lower cost than programs such as

1 HOW STATE HEALTH INSURANCE POOLS ARE HELPING AMERICANS

• Persons rejected for individual health insurance static. Since the inception of high risk insurance pools in in the commercial market; 1975, the total number of Americans who have been • Persons eligible for individual market portability insured by high risk insurance pools is probably at least under the Health Insurance Portability and 1,000,000. This is because, based upon data from several Accountability Act (HIPAA); and high risk insurance pools, about 20% to 25% of enrollees • Persons who are qualified for the federal Health in high risk insurance pools leave each year. In other Care Tax Credit (HCTC) program due to job words, about a quarter of enrollees in a high risk displacement related to foreign trade. insurance pool use it for one year or less and move on to group coverage through a new employer, individual There are 35 operational state high risk pools: Alabama, coverage, Medicare, and Medicaid. Alaska, Arkansas, California, Colorado, Connecticut, Florida, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Of the 200,000 Americans served by the high risk Louisiana, Maryland, Minnesota, Mississippi, Missouri, insurance pools, most have pre-existing health conditions Montana, Nebraska, New Hampshire, New Mexico, and/or chronic diseases such as cancer, diabetes, North Carolina, North Dakota, Oklahoma, Oregon, hypertension, heart disease, and obesity. South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, West Virginia, Wisconsin, and Wyoming. Without high risk insurance pools many of the chronically ill people would be denied coverage and face The majority of high risk insurance pools across the financial and health catastrophes. Or they would drive United States set premiums at about 150% of premium up insurance premiums in the individual market. This rates for a comparable individual policy sold in the could have the potential consequence of making commercial market. A few state high risk pools such as: insurance less affordable for millions more Americans. Minnesota, New Mexico, Oregon, Washington, West Virginia, and Wisconsin have High risk insurance pools charge established lower premium rates FACT: Studies show that premiums that are above than the average high risk commercial insurance rates because insurance pool rates. They range maintaining insurance coverage of the high cost associated with so from 110% to 134%. improves both access to health many high risk Americans care and health care status. For concentrated in one plan. The It is important to understand that high-risk individuals access to existence of high risk insurance high risk insurance pools are health care and monitoring is pools allows providers of individual intended to make coverage even more important if they are coverage in the private market to available. High risk insurance offer more affordable rates to non- pools were not created to address to avoid costly complications high risk individuals. the issue of affordability. Some associated with their conditions. states address this issue by seeking Source: NASCHIP Study FEDERAL AND STATE state and federal funds for GRANTS OFFER PREMIUM premium assistance programs. SUBSIDIES

Affordability of health care coverage is the over-arching Since 2002, the National Association of State issue for all forms of private market health insurance and Comprehensive Health Insurance Plans (NASCHIP) has is a challenging issue for high risk insurance pools. successfully supported congressional efforts to provide high risk insurance pools funding to conduct outreach HIGH RISK INSURANCE POOLS SERVE AN and marketing efforts, subsidize enrollee premiums, IMPORTANT SAFETY NET ROLE IN THE implement disease management programs, and help INDIVIDUAL INSURANCE MARKET reduce pool operating costs.

Despite the fact that high risk insurance pools differ HIGH RISK INSURANCE POOLS SERVE AS from one another in size, scope and eligibility, it is crucial STATE “GUARANTEED ISSUE” HEALTH to understand that they all play an important role as a INSURANCE “safety net” in the individual insurance market. High risk insurance pools offer an option for the self- Many of the high risk insurance pools serve as state employed, college students, workers with no access to “guaranteed issue” mechanisms under (HIPPA). That is, employer based group health coverage, and early retirees. when an individual leaves employment and exhausts any extension of benefits that is available, he or she is usually While the current number of Americans insured by high eligible for high risk insurance pool enrollment that risk insurance pools is about 200,000, that number is not provides full coverage for preexisting conditions.

2 HOW STATE HEALTH INSURANCE POOLS ARE HELPING AMERICANS

WAITING PERIODS NECESSARY month. No rate difference exists for gender. This example demonstrates that states offer a range of When individuals who are ineligible for HIPPA coverage deductible plans to fit individual needs. enroll in a high risk insurance pool they are usually subject to a pre-existing condition exclusionary period. Wide choice of deductible plans — Policy deductibles Without such a period there would be an incentive for typically range from $500 to $10,000. The wide range of people to enroll in a high risk insurance pool after they deductible plans helps individuals choose a policy with a develop serious health conditions. monthly premium that they can afford. Some states also offer a federally qualified, High Deductible Health Plan High risk insurance pools are sometimes criticized for (HDHP) for use with a Health Savings Account (HSA). imposing pre-existing condition exclusionary periods, but the necessity for fiscal soundness dictates that they do so. Comprehensive benefits — Health benefits provided Just imagine the result if you could buy auto insurance include: wellness, out-patient, in-hospital, prescription for your car after an accident or homeowner’s insurance drugs, x-rays and laboratory services, organ transplants after a fire. Auto and fire insurance would become cost and after care, cancer screens, mental health and prohibitive. chemical dependency treatment, children’s preventive services, services for autism spectrum disorders, chemo- The fact is that most existing high risk insurance pools therapy, home health care, maternity, and hospice (this is require pre-existing condition waiting periods of no more not an exhaustive list of benefits). than six to twelve months. High Lifetime Maximum FEATURES OF Benefit — Many high risk SUCCESSFUL HIGH RISK “All state high risk pools serve to insurance pools provide a high INSURANCE POOLS ensure that people with chronic maximum lifetime benefit, some illnesses have health insurance. The as much as $3 million or more. Each high risk insurance pool has unique characteristics, but existence of the high risk insurance Plan Commitment to Care there are certain key elements pools has helped some pool enrollees Management Resources — that serve as a model for a avoid bankruptcy. In 2006, the cost Many enrollees are offered disease successful high risk insurance of claims paid by the pools, management services to help pool. These characteristics them manage their chronic include: collectively, was $1.6 billion.” diseases. Chronic diseases – Lynn R. Gruber, President, Minnesota include: diabetes, congestive heart Non-Profit Corporation — Comprehensive Health Association failure, hypertension, rheumatoid Some high risk insurance pools arthritis, multiple sclerosis, and are organized as non-profit lupus. Similar programs are also organization. These pools are offered to enrollees with typically governed by a board of directors that includes complicated cases that have the potential for catastrophic health insurance industry representatives, enrollees, claims costs. Tobacco cessation programs are also insurance agents, and small business. The health available. insurance board members tend to be from companies responsible for paying a significant portion of the pool’s Promotion of On-Line Health and Wellness assessments that subsidize the plan costs not covered by Resources — Some state high risk health insurance enrollee premiums. pools currently provide on-line information and resources as an effective and cost-saving measure. These State Agency — Some high risk insurance pools are resources offer on-line and off-line healthy living organized as state agency programs. activities and information.

Affordable Premium Rates — Rates for most high risk Premium Subsidy Program for Low Income insurance pools range between 110% and 150% of Enrollees — High risk insurance pools have used average commercial and individual policy rates in the federal funding, when available, to help offset state. Some state pools’ current rates are as low as 110% operational expenses and to offer enrollees added of market rates. In the Minnesota high risk insurance benefits and premium subsidy programs. Many high risk pool, for example, the current premium for an enrollee insurance pools offer a premium subsidy program for who has a $2,000 deductible and is between 45-49 years enrollees at 150% to 300% of the federal poverty old is $250.20 a month. An enrollee in the same age guidelines. group with a $1,000 deductible plan pays $304.87 a

3 HOW STATE HEALTH INSURANCE POOLS ARE HELPING AMERICANS

REASON FOR DIFFERENCES CRITICS OF HIGH RISK INSURANCE POOLS FAIL TO SEE THE WEAKNESS IN As mentioned previously, high risk insurance pools are GUARANTEED ISSUE MANDATES not all alike. State politics dictate wide differences in policy relating to funding of pools. This has a direct Some high risk insurance pool critics complain that pool effect on premium rates, benefits offered, and limits on premiums are unaffordable for many potential enrollees. enrollment. Furthermore, bigger is not always better. The irony of this complaint is that residents of states that Small high risk insurance pools can offer more personal have adopted “guaranteed issue” of individual health services, case management, and disease management on a insurance policies (i.e., MA, NJ, NY, WA) have much smaller manager-to-patient ratio. experienced extremely high premiums for the guaranteed issue policies. In the case of the State of Washington, all NAIC MODEL ACT but one seller of individual health insurance policies left the state after guaranteed issue was mandated because In the late 1990’s, the National Association of Insurance the companies did not want to offer health policies in a Commissioners (NAIC) developed model legislation for state that lacked competition. Washington policymakers states to consider when establishing high risk insurance ultimately found it necessary to re-institute a high risk pools. A copy of that legislation may be obtained from insurance pool, which is operating well today. Further, a the NAIC. number of high risk insurance pools have premium subsidy programs for those who need financial CRITICS OF HIGH RISK INSURANCE POOLS assistance. Currently, we are not aware of any guaranteed issue state that has established a premium Could state high risk pools be improved? Certainly. subsidy program to help people afford those policies. Every state could serve more people, offer better rates, provide added benefits and resources When critics talk about waiting to produce more personal periods they often point to extreme responsibility, and improve chronic NASCHIP also strongly examples of a person diagnosed with disease management. supports the model cancer being forced to wait for legislation for state high risk enrollment in a high risk insurance Improvements to many high risk insurance pools developed by pool. What critics ignore is that these insurance pools are currently being individuals were often without discussed and considered by the National Association of insurance by choice. Health insurance lawmakers, and available state and Insurance Commissioners only became a priority for them after federal funding will likely determine (NAIC). a severe health condition manifested actions. – www.naic.org itself. Without waiting periods, the incentive for buying health insurance Some health policy and research responsibly is eliminated. groups are critical of high risk insurance pools. They point to what they claim to be INDIVIDUAL CASE STUDIES “unaffordable premiums,” “long waiting periods,” and lack of coverage of conditions such as maternity care. Now that we have taken a broad look at high risk Unfortunately, this is a myopic point of view and ignores insurance pools, it is important to take a personal look at the reality that high risk insurance pools are working well the individuals and families that are served by them. for so many Americans. Below are a few real examples of high risk insurance pool assistance to Americans. Many of the critics support universal coverage or a single payer national health care system. As a result, they fault Joanne’s Story high risk insurance pools in order to further an agenda. Joanne is a Redmond, Oregon resident and leukemia While NASCHIP shares the desire to see access to health patient. Joanne faced an uncertain future when she coverage for all Americans, we are dealing with realities learned last April that she would no longer have health of the current system. In the current health care system insurance available to her. Her health coverage was high risk insurance pools are necessary to provide going to end the day before she was to enter the hospital coverage to a vulnerable and uninsurable population. for treatment.

Representatives from the Oregon Medical Insurance Pool (OMIP) enrolled her in the state’s high risk insurance pool. OMIP, which became operational in 1990, was designed for residents turned down for

4 HOW STATE HEALTH INSURANCE POOLS ARE HELPING AMERICANS insurance because of pre-existing conditions. Joanne thousands of New Mexico residents who would not pays a monthly $577 insurance premium for a $500 otherwise qualify for health insurance. annual deductible plan that has a $1,000 annual out of pocket expense maximum, after payment of the ** ** ** deductible. These are the stories of just three of the nearly 200,000 Currently Joanne is waiting for a donor for a stem cell Americans who turn to high risk insurance pools to transplant. Without Oregon’s high risk insurance pool, provide quality health care, which is life-saving in some she would not be able to pay for the $250,000 transplant instances. procedure. CONCLUSION Betty’s Story After being employed for 15 years in various companies High risk insurance pools in 35 states across the country that provided health insurance benefits, Betty became play an essential role in today’s health insurance system. self-employed and was no longer covered. She applied for an individual health insurance policy and was turned With the decline of employer-based health insurance down because she had diabetes. coverage and the rise of an individual health insurance coverage market, it is important that policymakers, Fortunately, Betty lives in Minnesota where there is a academics, consumers, and insurers have current and high risk insurance pool – the Minnesota Comprehensive accurate information on high risk insurance pools. Health Association (MCHA), which was established in 1976. Betty secured coverage through MCHA and has As health care reform is debated in the new Congress, been insured since 1988. Betty has MCHA’s federally- policymakers need to have an understanding of high risk qualified, High Deductible Health Plan — which is a insurance pools and the role that they currently play. qualified plan for a Health Savings Account. Her premium payment is $447.31 a month and she pays a For now, state high risk insurance pools ensure that $3,000 annual deductible before the plan offers 100% thousands of Americans are safe with health insurance coverage. coverage that protects them until health policymakers in each state and the federal government agree on a better “Without MCHA, I am not sure what I would have way. done,” said Betty. “By having MCHA, I have been able to have peace of mind that I will not be financially ruined ABOUT NASCHIP and have therefore been able to work, pay taxes, and in those 20+ years have only missed a few days of work. The National Association of State Comprehensive The high risk insurance pool insurance has permitted me Health Insurance Plans (NASCHIP) was created in 1993 to keep my diabetes under control.” to provide educational opportunities and information sharing among state high risk pools, policymakers and Patty and Courtney’s Story the public. Patty and her husband lived with their three children in Las Cruces, New Mexico. In 1982, they started their Since the first high risk insurance pools were established own business and found health insurance unaffordable. in Connecticut and Minnesota, they have grown in The premium was more than their house and car number and evolved to help address access to health payments combined. insurance for Americans with chronic health conditions. High risk insurance pools are accepted, proven programs Patty’s first child, Courtney, was born with Down that serve a specific need. They contribute an important Syndrome. Despite Courtney’s good physical health, no element of stability in this country’s health insurance health insurance company would cover her. Patty talked system. with her state senator about this dilemma. At the time, the senator was aware of several existing high risk For more information visit www.NASCHIP.org. insurance pools in other states. Patty then contacted over 20 chronic disease organizations asking for their support for a bill to establish a high risk insurance pool in New Mexico. She worked with the senator’s staff to draft legislation. The senator persuaded 40 of 41 senators to sponsor the bill and it passed in January 1987. After more than twenty years in existence, the program has proven to be an overwhelming success, serving

5 HOW STATE HEALTH INSURANCE POOLS ARE HELPING AMERICANS

STATE HEALTH INSURANCE HIGH RISK POOL WEBSITES AND PHONE NUMBERS NASCHIP Pool Directory 2008 – 2009

ALABAMA FLORIDA KENTUCKY Wynnette Smith Jerome Ashford Tonya B. Parsons Program Director Executive Director Executive Director Alabama Health Insurance Pool Florida Comprehensive Health Association Kentucky Access Program P.O. Box 304900 820 E. Park Ave, D-200 P.O. Box 1380 Montgomery, AL 36130-4900 Tallahassee, FL 32301 Frankfort, KY 40602-1380 (334) 263-8311 (850) 309-1200 (502) 573-1026 [email protected] [email protected] [email protected] www.alseib.org www.kentuckyaccess.com IDAHO ALASKA Joan Krosch LOUISIANA Cecil Bykerk Health Insurance Specialist Leah Barron Executive Director Idaho Individual High Risk Reinsurance Pool Chief Executive Officer Alaska Comprehensive Health Insurance 700 West State Street, Third Floor Louisiana Health Plan Association Boise, ID 83720-0043 P.O. Drawer 83880 9643 Oak Circle (208) 334-4300 Baton Rouge, LA 70884-3880 Omaha, NE 68124-2767 [email protected] (225) 926-6245 (402) 501-8701 www.doi.idaho.gov [email protected] [email protected] www.lahealthplan.org www.achia.com ILLINOIS Timothy C. Sullivan MARYLAND ARKANSAS Executive Director Richard Popper Nick Thompson Illinois Comprehensive Insurance Plan Executive Director General Counsel 320 W. Washington, Suite 700 Maryland Health Insurance Plan Arkansas Comprehensive Health Insurance Pool Springfield, IL 62701-1150 201 E. Baltimore Street, Suite 630 425 West Capitol Ave, Suite1800 (217) 782-6333 Baltimore, MD 21202 Little Rock, AR 72201 [email protected] (410) 576-2055 (501) 370-4234 www.chip.state.il.us [email protected] [email protected] www.marylandhealthinsuranceplan.state.md.us www.chiparkansas.org INDIANA Doug Stratton MINNESOTA CALIFORNIA Executive Director Lynn Gruber Leslie Cummings Indiana Comprehensive Health Insurance President Executive Director Association Minnesota Comprehensive Health Association Managed Risk Medical Insurance Board 9465 Counselors row, Suite 200 5775 Wayzata Blvd., Suite 910 P.O. Box 2769 Indianapolis, IN 46240 St. Louis Park, MN 55416 Sacramento, CA 95812-2769 (317) 877-5376 (952) 593-9609 (916) 324-4695 [email protected] [email protected] [email protected] www.ichia.gov www.mchamn.com www.mrmib.ca.gov IOWA MISSISSIPPI COLORADO Cecil Bykerk Lanny Craft Suzanne Gamble Executive Director Executive Director Executive Director Iowa Comprehensive Health Association Mississippi Health Insurance Risk Pool CoverColorado 9643 Oak Circle Association 425 S. Cherry #160 Omaha, NE 68124-2767 P.O. Box 13748 Denver, CO 80246 (402) 501-8701 Jackson, MS 39236 (303) 863-1960 [email protected] (601) 899-9967 [email protected] www.hipiowa.com [email protected] www.covercolorado.org www.mississippihealthpool.org KANSAS CONNECTICUT Ed Fonner MISSOURI Karl Ideman Executive Director Vernita Bridges McMurtrey President Kansas Health Insurance Association Executive Director Pool Administrators, Inc. 420 S. W. 9th Street Missouri Health Insurance Pool 100 Great Meadow Road, Suite 704 Topeka, KS 66612 3100 Broadway, Suite 210 Wethersfield, CT 06109 (785) 296-7850 Kansas City, MO 64111-2553 (800) 842-0004 [email protected] (800) 821-2231 [email protected] www.khiastatepool.com [email protected] www.hract.org www.mhip.org

6 HOW STATE HEALTH INSURANCE POOLS ARE HELPING AMERICANS

MONTANA OKLAHOMA UTAH Cecil Bykerk Frazier Farley Tomi Ossana Executive Director Executive Director Executive Director Montana Comprehensive Health Association Oklahoma Health Insurance High Risk Pool Utah Comprehensive Health Insurance Pool 9643 Oak Circle P.O. Box 50429 1464 E. Emerson Avenue Omaha, NE 68124-2767 Midwest City, OK 73140-5429 Salt Lake City, UT 84105 (402) 501-8701 (405)-741-8434 (801) 485-2830 [email protected] [email protected] [email protected] www.mthealth.org www.okhrp.org www.selecthealth.org/hiputah

NEBRASKA OREGON WASHINGTON Adam Steffen Howard "Rock" King Karen Larson Manager Executive Director Executive Director Nebraska Comprehensive Health Insurance Oregon Medical Insurance Pool Washington State Health Insurance Pool Association 250 Church St., SE P.O. Box 329 P.O. Box 3248 Salem, OR 97301 Bow, WA 98232-0329 Omaha, NE 68180-0001 (503) 373-1692 (360) 766-6336 (402) 548-4593 [email protected] [email protected] [email protected] www.omip.state.or.us www.wship.org www.nechip.com SOUTH CAROLINA WEST VIRGINIA NEW HAMPSHIRE C. Michael Jordan Alfreda Dempkowski Mike Degnan Chairman Executive Director Executive Director South Carolina Health Insurance Pool Access West Virginia New Hampshire Health Plan P.O. Box 61173 P.O. Box 50540 One Pillsbury Street, Suite 200 Columbia, SC 29260-1173 Charleston, WV 25305-0540 Concord, NH 03301-3570 (800) 868-2500 ext. 42757 (304) 558-8264 (603) 225-6633 [email protected] [email protected] [email protected] www.doi.sc.gov www.accesswv.org www.nhhealthplan.org SOUTH DAKOTA WISCONSIN NEW MEXICO Jill Kruger Amie Goldman Patty Jennings Manager Chief Executive Officer Executive Director South Dakota Risk Pool Health Insurance Risk-Sharing Authority New Mexico Medical Insurance Pool 500 East Capitol Avenue 33 E. Main Street, Suite 230 P.O. Box 6726 Pierre, SD 57501 Madison, WI 53703 Santa Fe, NM 87502 (605) 773-3148 (608) 441-5777 (505) 424-7105 [email protected] [email protected] [email protected] http://riskpool.sd.gov www.hirsp.org www.nmmip.org TENNESSEE WYOMING NORTH CAROLINA David Hilley Lori Mischan Michael Keough Director Administrator Executive Director Access Tennessee Wyoming Health Insurance Pool North Carolina Health Insurance Risk Pool 26th Floor, WRS Tennessee Tower 106 East 6th Avenue 3739 National Drive, Suite 228 Nashville, TN 37243-1700 Cheyenne, WY 82002-0440 Raleigh, NC 27612 (615) 253-8576 (307) 777-7401 (919) 783-5766 [email protected] [email protected] [email protected] www.accesstn.gov www.whipcoverage.com www.nchirp.org TEXAS NORTH DAKOTA Steve Browning Kathy Robley Executive Director Administrator Texas Health Insurance Risk Pool Comprehensive Health Association of North 1701 Directors Blvd. #120 Dakota Austin, TX 78744 4510 13th Avenue, S.W. (888) 398-3927 Fargo, ND 58121-0001 [email protected] (701) 282-1235 www.txhealthpool.org [email protected] www.chand.org

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