Enrollment Figures Low for High-Risk Pools in California, Nationwide
The high-risk health insurance pools established under the federal health reform law have enrolled fewer residents than expected since they began operating this summer, the AP/Boston Globe reports.
The reform law established 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. California and many other states have opted to operate their own high-risk pools, while the federal government is running the pools inÂ some states.
To qualify for PCIP, individuals must:
- Be U.S. citizens or legal residents;
- Have been uninsured for at least six months; and
- Have been denied insurance coverage because of a pre-existing condition.
Enrollment Numbers Low
In April, federal officials estimated that about 375,000 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.
However, California has received fewer than 450 applications for its high-risk pool, even though the state has the funds to cover about 20,000 residents, according to a state official.
Wisconsin has the capacity to cover 8,000 residents, but has received fewer than 300 applications. As of early September, Texas had enrolled 200 residents.
Possible Contributing Factors
Experts and state officials say the high-risk pools might be enrolling fewer residents than expected because:
- Premiums might be unaffordable for some individuals;
- Many people might not meet the requirements that they lack insurance coverage for six months and have been denied coverage because of a medical condition; and
- Some high-risk pools have a high deductible for prescription drugs.
Federal Official Weighs In
Jay Angoff -- director of HHS' Office of Consumer Information and Insurance Oversight -- said federal officials believe the high-risk pools are "getting off to a good and orderly start."
Angoff said that the pools began operating within a fast time frame and that he expects more individuals to enroll within the coming months (Alonso-Zaldivar, AP/Boston Globe, 10/3).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.