States Might Lose Funds for High-Risk Pools Over Policies Already in Place
At least five states are concerned that rules they adopted before the new health reform law was enacted might preclude them from receiving a share of the $5 billion allotted under the overhaul to help states establish high-risk insurance pools, Politico reports (Kliff, Politico, 7/20).
On July 1, federal health officials launched the Pre-Existing Condition Insurance Plan that establishes the pools until 2014, after which private insurers are required to accept all applicants regardless of pre-existing conditions. To qualify, residents must have been uninsured for at least six months and have been denied insurance coverage because of a pre-existing condition (California Healthline, 7/1).
'Guaranteed Issue' Coverage
Five states -- Maine, Massachusetts, New Jersey, New York and Vermont -- have "guaranteed issue" insurance, under which residents cannot be denied health coverage because of a pre-existing condition.
The states also have some type of community rating that prohibits insurers from setting extremely high rates based on factors like gender and health status.
The programs generally have helped to make coverage more accessible and affordable for uninsured residents in those states. As a result, those states likely will have fewer residents eligible for the high-risk pools created by the federal overhaul and will, therefore, receive a smaller portion of the $5 billion.
What To Do?
Both federal and state officials indicated there might be a way to alleviate the states' concerns.
Richard Popper, director of insurance programs in HHS' Office of Consumer Information and Insurance Oversight, said the agency has been trying to work around the guaranteed issue situation to allow states to participate in the program.
David Neustadt, a spokesperson for the New York State Insurance Department, said that the department is working with HHS and that he believes it is possible to find a solution to the problem (Politico, 7/20).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.