by
Astrid Fiano, DOTmed News Writer | May 06, 2010
DOTmed zooms in
on key reform issues
in an ongoing series
In the past week, several states have had to decide whether they want to work with the Federal government to administer a "high-risk" pool of health insurance coverage, or opt out of the pool altogether. The high-risk pools are part of the expansion of coverage in health care reform mandated in the Affordable Care act passed this year. Many states already have various forms of high-risk insurance pools for those citizens unable to otherwise obtain insurance.
As reported earlier (DM 12186), the Department of Health and Human Services (HHS) asked the states to notify HHS regarding participation by April 30. The temporary program is intended to bring coverage to people with pre-existing conditions. A permanent ban on rejecting coverage based upon pre-existing conditions will be implemented in 2014, when the temporary high-risk pool program ends. According to a recent report by Jenny Backus, Acting Assistant Secretary for Public Affairs, 45 states allow discrimination against individuals based on pre-existing conditions.
What constitutes a pre-existing condition? It can be an injury from an accident, a minor condition, or a major chronic condition like hypertension or diabetes. This can include any condition for which an individual has received medical advice, diagnosis, care, or treatment, or by some definitions, if the person should have been aware of the problem.
OPTIONS FOR STATES
The states have several different options regarding the high-risk pools. They can operate a new high-risk pool along with any existing pool; establish a new pool if the state doesn't have one; build on other coverage programs in the state that cover high risk persons; contract with a carrier for subsidized coverage for the eligible individuals; or not participate. Should a state choose not to participate, the residents of the state will still have the opportunity to obtain coverage through the federal high risk pool, administrated by HHS.
The pools should be created by July 1 of this year. Around $5 billion in federal funds have been earmarked for this program; the program is entirely federally funded so if a state participates, it will receive a portion of that money. The funds will be allotted through a calculation involving factors such as the population demographics of the state, demographics of the uninsured, and geographic cost -- similar to funding for the Children's Health Insurance Program (CHIP). HHS would reallocate allotments after no more than a two-year period, based upon enrollment and expenditures within the state.
