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High-Risk Insurance Pools Begin Enrollment

Elyas Bakhtiari, for HealthLeaders Media, July 1, 2010

Most high-risk insurance pools for patients who can't obtain coverage because of pre-existing conditions began enrollment Thursday, slightly past the 90-day deadline established by the Patient Protection and Affordable Care Act.

Under the legislation, states had the option of administering their own plans or letting their residents opt-in to a plan run by the Department of Health and Human Services. Twenty-nine states plus the District of Columbia decided to operate their own plans with funding from the federal government. The remaining 21 will rely on the federal Pre-existing Condition Insurance Plan (PCIP), the name for the high-risk pools announced by Secretary Kathleen Sebelius Thursday.

HHS also launched of a new consumer website, www.healthcare.gov, that contains information on how the plans are administered and how patients can enroll.

Last week, Republicans in Congress questioned the effectiveness of the pools after the Congressional Budget Office released a report suggesting the $5 billion allocated for the pools in reform legislation wouldn't be enough to cover the costs. If HHS doesn't restrict enrollment or services, the actual cost to the federal government could be two or three times higher, the report said.

On Wednesday, Sebelius attempted to address some of the cost concerns in a conference call, according to The Hill. Options for controlling costs ranged from reducing benefits to redistributing funds to turning people away from the pools. However, Sebelius did not say she would ask for more funds from Congress.

Although the number of people who could potentially qualify for the program is in the millions, enrollment will likely be limited to 200,000-700,000 during the 2011-2013 period. By 2014, patients with pre-existing conditions will no longer need the high-risk pools because they will be able to obtain coverage from private insurers.

While the federal government will provide funds for administering the pools, they will be largely funded through member premiums and cost-sharing. Participants will be required to pay a premium "that is not more than the standard individual health insurance premium in their state for insurance that covers major medical and prescription drug expenses with some cost-sharing," according to the HHS announcement.

That could range from as little as $140 a month to as much as $900, Richard Popper, deputy director of the the new Office of Consumer Information and Insurance Oversight. HHS, told the Associated Press.

Some states, including California and Illinois, failed to meet the July 1 deadline and will not begin enrollment until later in the year. HHS expects all states to begin enrollment by the end of the summer.


Elyas Bakhtiari is a freelance editor for HealthLeaders Media.

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