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Enrollment in High-Risk Health Insurance Pools Still Below Expectations

Enrollment in the high-risk health insurance pools created under the health reform law has not reached expectations, with just 8,011 U.S. residents enrolled nationwide after two or three months of operation in most states, according to HHS, the New York Times reports.

Background on High-Risk Pools

The reform law established the pools, called the Pre-Existing Condition Insurance Plan, to provide coverage to individuals with pre-existing conditions prior to 2014, when private insurers are required to accept all applicants.

To qualify for PCIP, individuals must have been uninsured for at least six months and been denied insurance coverage because of a pre-existing condition (Sack, New York Times, 11/4).

In April, federal officials estimated that about 375,000 U.S. residents would gain coverage through the high-risk pools. Some experts questioned whether the $5 billion allocated to the program would be sufficient to cover those residents (California Healthline, 10/4).

In addition, a recent study by the Commonwealth Fund revealed that an estimated six million of the country's 50.7 million uninsured residents might be eligible for the new pools.

Enrollment Low

However, enrollment in most states as of Nov. 1 was below 10% of capacity. For example, 21 states have enrolled fewer than 50 residents and New York and Florida each have enrolled fewer than 300.

Administrators of the pools attribute low enrollment to several reasons:

  • Lack of awareness among a hard-to-reach target population;
  • A requirement that applicants be uninsured for at least six months; and
  • The high cost of premiums, despite being set at market rates.

HHS Response

Richard Popper, director of insurance programs at HHS, refused to say whether he was disappointed with enrollment rates. He said, "It takes a while for advocates and stakeholders to realize there's this new plan," adding, "We're delighted the program is out there and making a difference in people's lives and keeping people alive."

Meanwhile, HHS on Jan. 1 will begin to give consumers choices of different plans with different costs and deductibles, in hopes it will draw more interest (New York Times, 11/4).

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