JEFFERSON CITY - More than 16,000 of the sickest and most uninsurable Missourians could be covered under the state health care pool if it wasn't for high insurance premiums, according to the pool's director.

Vernita Bridges-McMurtrey, executive director of Missouri Health Insurance Pool spoke before the Joint Committee on Tax Policy Tuesday. She said the premium level is set by statute and it is one of the highest premium thresholds in the country.

The premium level is determined yearly by averaging the premiums of the five largest carriers of individual health insurance in the state. By statute the premium must be between 125 percent and 200 percent of the rate charged by a private insurance company.

"We think it could be as many as 20,000 if people had full access to this program," Bridges-McMurtrey said.

The nonprofit Missouri Health Insurance Pool program is administered through an agreement between the state, Anthem Blue Cross and Blue Shield and Blue Cross and Blue Shield of Kansas City. The program is designed for people who are unable to get health care coverage because of high medical risk.

Bridges-McMurtrey said as of the end of November there are about 3,700 people in the pool. She said it is the highest enrollment since the program started in 1991.

Those enrolled make up some of the state's neediest cases.

Bridges-McMurtrey said a third of the nearly 3,700 people in the pool are within 200 to 300 percent of the federal poverty level.

"We have here a population of Missourians that are directly impacted by the economy and unemployment," she said. "We are their only alternative for insurance coverage."

Bridges-McMurtrey said 34 other states have health insurance pools. She said Missouri's program has one of the smallest enrollments.

"This is a relatively small program considering how many uninsured and underinsured Missourians are in the state who are actually eligible for this program," she said. "I think the program is limited only because we have... very high premium structure for this program."

The state has one of the highest premium thresholds in the country.

"Missouri is unique in that we have always set our threshold higher than the rest of the country," Bridges-McMurtrey said. The high threshold is due to the statute requirements

For example, a 50-year-old man may pay a $600 monthly premium and a 50-year-old woman may pay a $800 monthly premium, Bridges-McMurtrey said.

Bridges-McMurtrey said people who qualify are uninsurable, no matter the cost. So people who could be insured in the private sector at a higher cost would not qualify.

In 2008 the state paid about $22 million in medical and prescription claims for the pool. There was a 12 percent increase in 2009 because an additional 700 people joined the program, she said.

For example, a 50 year old man would pay a $600 monthly premium and a 50-year-old woman would pay a $800 monthly premium, Bridges-McMurtrey said.

"The use and access of the program is directly impacted by the very high premium level that we're charging as dictated by statute," Bridges-McMurtrey said.

She also said the program is not well known, which could also be a factor in the low enrollment.

Sixty percent of the program's funding comes through premiums paid by people in the pool. The program has also received federal funding for the last 3 years. Bridges-McMurtrey said federal funding would increase if the state lowered premiums for the program.

"States with higher enrollment in their programs received about double federal funding for the operation of their pools," Bridges-McMurtrey said. "So we are paying for having such low enrollment."

Rep. Mike Sutherland, R-Warrenton, said it is important to look at the program because it addresses a commonly overlooked group.

"It doesn't matter a lot of times what we do, they're not going to be able to get insurance except for through this program,"  Sutherland said at the committee meeting. "And we sometimes get off track or get kind of side tracked on other issues and nobody wants to talk about this, which probably is the issue that is most important."