High-Risk Failure?

One of the key elements of the health-care reform bill that President Obama signed into law earlier this year is a requirement — effective starting in 2014 — that health insurance companies no longer deny coverage because of a preexisting medical condition. Paired with this requirement will be another: that nearly all people maintain health insurance coverage, to prevent people from simply purchasing insurance when they get sick. In principle, these changes will both expand coverage and reduce the average cost of a health insurance policy, since more healthy people will be covered.

In the still more than three years until 2014, however, insurance companies can still deny coverage to people with preexisting conditions in states where such discrimination is allowed. So the health-care bill created a temporary solution to the problem of the “uninsurable”: special high-risk coverage pools funded by $5 billion of federal money, in which enrollees pay premiums that approximate what they would pay if they had no preexisting condition. Twenty-seven states chose to operate their own high-risk pools; the rest signed on to the federal government’s pool. The pools became operational on July 1.

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Initially, some experts feared that the insurance pools would be overrun with enrollment, causing the $5 billion to run out before 2014; the government’s own health-care actuary predicted it would run out in 2012. But as a recent article in The New York Times notes, right now enrollment is far below what anyone expected. Instead of the predicted hundreds of thousands of participants, the new pools have drawn just over 8,000 people, according to the US Department of Health and Human Services. Among the states, Pennsylvania leads with 1,657 enrollees, according to citizensvoice.com; 21 states have fewer than 50 participants, and even large states like New York and Florida each have fewer than 300 participants. Why so low? It appears that the pools are simply not well publicized. The target audience — people without insurance and with a condition that disqualifies them for regular insurance — is simply too hard to find, even though it may number 6 million people. And the federal government is understandably reluctant to spend money on advertising when only a fraction of those reached would be eligible for the pools.

What do you think — does low enrollment in high-risk health insurance pools constitute a failure of the program? Or is it good that the government might save some money? Do you have any ideas about how to spread the word to people who might be eligible for the program? Leave a comment below!

If you or someone you know might be eligible to join a high-risk pool, for more information visit www.HealthCare.gov or call (866) 717-5826.

  • Robert

    Most of the people without insurance have it because they cannot afford either noraml health insurance or subsidized insurance. When it cost up to $7000 per year for the average guy 50 years old for insurance (with or without pre existing conditions, most cannot afford it. If they had high paying jobs they would be covered by their employer.

    If they do not ahve a high paying job, they most likely do not ahve health beenfits they can afford. It is that simple.

    Stop the garbage and let people without insrurance, pay the same price the insurance companies pay for their participants and all will be well. I could easily pay for a procedure what Medicaid or medicare pay for the procedure. I cannot afford what the hospital will chanrge me if I do not have insurance or govenment aid.

    My hospital and doctor bills totaled over $40,000 for procedures the hospital and doctors would have been paid less than $3000.00 for. The $3000.00 I could afford. The $40,000 I cannot and has costs me dearly for over three years making payment every month.

    Fix that problem, and you have fixed the health care issue without spending trillions of dollars.
    It is simply too simple to work poorly enough for the politicians to profit from.