High risk pools in federal health reform

Questions are surfacing about the federal reform bill’s provision to create a high risk pool will be implemented. The pool is meant to provide temporary coverage for people locked out of the insurance market until the bill’s pre-existing condition ban for adults becomes effective in 2014. People who need high risk pools include those timing out of COBRA, those turned down for individual coverage, people who don’t have access to COBRA because their former employer went out of business, among others. CT has had a high risk pool since 1975 but it is very small (2,336 as of 12/31/08). We have explored the pool as an option for many clients who call our helpline, but it has never been an affordable option. CT state law sets the rates charged in the pool to between 150 and 200% of standard market rates, which are already too high for many. Thirty five states have high risk pools, most of which also don’t meet the growing need. But MN’s high risk pool has much higher enrollment for a variety of reasons. One of the most important is that MN’s pool rates are between 101 and 125% of standard market rates by law. A recent blog from Health Affairs outlines other important provisions that need to be included in the federal pool if it will be useful to more than a handful of people. Building the high risk pool is only one of many devils in the details of health reform. Advocates from ME, MA and VT have been through this and emphasize that passing reform is only step 1A; the hard work starts now.
Ellen Andrews