California Healthline Daily Edition

Summaries of health policy coverage from major news organizations

High-Risk Pools Launch Today; Coincides With New Federal Website

On Thursday, U.S. health officials launched the Pre-Existing Condition Insurance Plan, a provision of the new health reform law that aims to temporarily provide coverage to individuals with health problems through high-risk insurance pools, the AP/Chicago Tribune reports (Alonso-Zaldivar, AP/Chicago Tribune, 6/30).

Twenty-nine states and the District of Columbia have elected to administer their own pools, while 21 states have opted to let the federal government run the pools.

According to the Wall Street Journal, coverage under federally run pools is expected to commence on Aug. 1 for consumers who apply by July 15. However, several states -- including California, Maryland and Michigan -- do not anticipate coverage being available in their pools until September.

Program Details

The program will cover primary care, and specialist- and hospital-administered treatment for eligible U.S. residents (Adamy, Wall Street Journal, 7/1).

The pools are modeled after CHIP, which allows states the flexibility to alter benefits and premiums to reflect the needs of their marketplace, according to Richard Popper, deputy director of HHS' Office of Insurance Information and Oversight (Reichard, CQ HealthBeat, 7/1).

To qualify, individuals must have been uninsured for at least six months and have been denied insurance coverage because of a pre-existing condition, possibly requiring a letter from a physician.


Monthly premiums will range from $140 to $900, based on a person's age and state of residence.

For example, a 50-year-old California resident could expect to pay $575 monthly for a comprehensive policy with a $1,500 annual deductible and $2,500 annual cap on out-of-pocket expenses.

The program will not charge enrollees more because of their medical condition (Wall Street Journal, 7/1). Independent experts estimate that premiums will average between $400 and $600 monthly, with younger people paying less (AP/Chicago Tribune, 6/30).

Enrollment and Funding Concerns

HHS officials have said 200,000 U.S. residents will be covered through the pools at one time, and the program could cover as many as 350,000 U.S. residents in total because of patient turnover (CQ HealthBeat, 7/1).

The government has allotted $5 billion to fund the pools until 2014, when insurers will be barred from denying coverage based on pre-existing health conditions, and low- and middle-income U.S. residents will become eligible for insurance subsidies (AP/Chicago Tribune, 6/30).

However, the Congressional Budget Office has estimated the program could require an additional $5 billion to $10 billion in funding to meet demand, which the agency predicts could reach 700,000 U.S. residents by 2013. Meanwhile, Medicare economists estimated that 375,000 residents would enroll this year and that the program would run out of funding by the end of 2011 (Alonso-Zaldivar, AP/Philadelphia Inquirer, 6/30).

Obama Administration Unveils New Health Care Website

The Obama administration on Wednesday unveiled its new website, the Washington Post reports. On the site, U.S. residents can apply for the high-risk pools.

The site also provides information on a wide range of public and private health insurance plans

For example, the site offers insurance plan information based on an individual's income, job status and ZIP code, and also allows users to see how their coverage options might change as provisions of the new reform law take effect.

Federal health officials expect the site to list prices and offer plan comparison charts by October (Aizenman, Washington Post, 7/1).

This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.