Gov. Rick Perry, who has railed against federal health care reform, is pushing thousands of Texans in the state's high-risk insurance pool into the marketplace set up by the Affordable Care Act.

An estimated 23,000 members of the Texas Health Insurance Pool were notified last month that their coverage would end Dec. 31 and that they would need to enroll in new coverage through the federal marketplace at healthcare.gov or buy it from an insurance company, said the insurance pool's executive director Steven Browning in an email.

New coverage must be bought by Dec. 15 to ensure continuous coverage on Jan. 1, 2014. Pool coverage will not extend beyond Jan. 1, no matter whether a member is hospitalized at year's end, Browning said.

Texas is among 35 states that operate high-risk insurance pools for residents with pre-existing health conditions, including cancers, heart disease and diabetes, and who can't find coverage elsewhere. Many of the programs will close next year and require members to buy coverage in the insurance marketplaces, according to the National Association of State Comprehensive Health Insurance Plans.

Perry signed a bill this summer calling for the end of the Texas insurance pool, which began in 1998. The pool primarily is funded by policyholders' premiums and insurance industry assessments. It also receives some federal grant money, but no state money.

Josh Havens, a Perry spokesman, said maintaining the state insurance pool only would have duplicated federal efforts and would not be a best use of state resources.

Against Obama act

Perry has been a strong opponent of President Barack Obama's health care law, saying in August: "Texans are already subject to too much costly and burdensome federal regulation, and Obamacare only makes the problem worse."

Browning, patient advocates and patients said pool members should be able to find coverage as good or better than that offered in the pool. Those in the pool typically pay two times the market rate for insurance.

Stacey Pogue, senior policy analyst with the Center for Public Policy Priorities, said pool insurance is coverage of last resort for many people because of its high cost. She said it's no surprise that Texas and many other states are closing their high-risk insurance programs and steering people toward the marketplaces.

"It's a broken insurance market," Pogue said. "Nothing makes sense to have it in the future. Most states have looked at doing this."

After comparing marketplace and pool plans, she said her organization found that all pool members would benefit in the marketplace, which offers subsidies for those who qualify. However, Pogue said, some members might be anxious about the closure because they've never had to shop for insurance.

"Some people have been in the pool since 1998 when it opened," she said, adding that she thinks Browning is trying to ease the transition for members.

Start search now

The insurance pool website lists links to several organizations and agencies that have information about the marketplace, as well as subsidy calculators. It also includes the notification sent to all members, plus answers to frequently asked questions about marketplace plans.

Pogue recommended that risk pool members, many of whom require frequent medical care, begin researching marketplace plans well in advance of the Dec. 15 deadline to avoid coverage breaks.

Houston resident Margaret Kallsen said state health insurance pool officials twice notified her that the program would close Dec. 31. She estimates her monthly $673 risk pool premium could be cut almost in half based on research she has done on marketplace premiums and subsidies.

Kallsen, 61, has been a member of the insurance pool about five years.

"It sounds good," she said, adding that chronic arthritis and obesity made it impossible for her to get insurance outside the risk pool. Her husband, who suffered from lymphoma and kidney and heart disease, also was in the risk pool until he turned 65 and qualified for Medicare. Kallsen said his premiums were $980 a month.

"The only reason we were able to afford it was because I saved about a third of my income for the last four or five years I was working," she said.

She said she looks forward to buying insurance in the marketplace and recommends everyone thoroughly research the plans before buying one.

"If you have doctors you like, ask them what plans they accept," Kallsen said.