Kaiser, Anthem Show Little Interest in New Federal High-Risk Pool
Neither Kaiser Permanente nor Anthem Blue Cross plan to participate in the new high-risk health insurance pool that California is creating under the federal health reform law, the Sacramento Business Journal reports.
Both insurers already participate in the state's existing high-risk pool.
Background on High-Risk Pools
The federal reform law set aside funds to create regional high-risk insurance pools for residents unable to obtain coverage in the private health insurance market because of pre-existing conditions.
The pools would operate until 2014, when health insurers will be prohibited from rejecting patients based on pre-existing conditions.
California's Existing Program
California plans to runÂ the federally supported high-risk pool alongside its existing program. Of the 6,923 residents covered under the state's existing high-risk pool as of June 1:
- Kaiser covered 4,073 residents; and
- Anthem covered 2,816.
Reasons for Disinterest
Lesley Cummings -- executive director of the Managed Risk Medical Insurance Board, which manages both high-risk pools -- said Kaiser and Anthem might have shied away from the federally supported pool because of concerns over the costs of supporting new high-risk enrollees. She added that the insurers also might be focusing on changes to the insurance market slated to take place in 2014.
An Anthem spokesperson said the companyÂ declined to participate in the federally supportedÂ high-risk pool because the program is "temporary in nature and ... would require significant changes to our existing systems in order to implement."
A Kaiser spokesperson said the insurer will continue to participate in the existing state-run program.
Next Steps for New Federally SupportedÂ Pool
On July 7, state officials requested proposals for administrative vendors to oversee billing, enrollment, outreach and eligibility for the new federally supported high-riskÂ pool. They also sought bids for a third-party administrator to handle claims, pharmacy benefits and a provider network.
MRMIB staff plan to recommend potential vendors on Aug. 5 and hold contract negotiations soon after. The federally supported pool is slated to begin this September (Robertson, Sacramento Business Journal, 7/23).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.