High Risk Pools for the Sick and Uninsured

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An important feature of the new health care law is coming into effect tonday, July 1st. $ 5 billion of federal funds has been allocated to cover those with significant pre-existing medical conditions such as diabetes or cancer until 2014 when health insurance exchanges go into effect and prevent discrimination based on on pre-existing conditions. I and all other primary care doctors I know each have many patients with just this problem.

This new feature, which was supposed to be in effect last week, creates federal high-risk insurance pools to help these patients with pre-existing conditions buy subsidized insurance until 2014. With the help of federal subsidies, patients will be facing insurance premiums between $140 and $900 per month. More than 200,000 people are eligible nationwide, probably closed to 500,000, still a small percentage of the uninsured. The program is administered by Health and Human Services. Twenty-one states have asked HHS to run the program for them, and 29 states and the District of Columbia will run the program themselves.

There are already significant problems with the program_

  • 10 states are working through administrative problems which will take months to resolve.
  • Michigan is just accepting bids from companies to manage the program. Illinois is also in the bidding process.
  • California is still involved in passing laws to allow the program to take hold
  • Florida is concerned that the $350 million they are allocated won't be sufficient.
  • To qualify, a person must be without health insurance for 6 months. There is concern that the program will be filled up too quickly and will have to be capped in several states. The Congressional Budget Office, and Richard Foster, chief actuary of HHS, have determined that the $5 billion may run out by 2011.
  • There is a great deal of variability between the states which may delay implementation and create additional bureacratic tie-ups.. Several states, including Colorado, Maryland, North Carolina, and California, already have high risk pools and want the federal government to fund them. Several other states, including Michigan, New York, and Pennsylvania, don't have the pools but will establish them with federal funds. Another group of states, including Texas and Alabama, won't use their pools and want the feds to make new ones. And another group including Arizona, Georgia, Nevada, and Virginia, have never had pools and have asked the feds to make them.
  • Some states, including Virginia and Louisiana, are in the process of suing the federal government over the possible unconstitutionality of the whole health reform bill, and would hardly seem motivated in the meantime to administer part of it.
  • Finally, those who want this federal support but who are already insured through the pre-existing high risk pools in 35 states will first have to drop the insurance they do have for 6 months in order to qualify.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of a new ebook: Swine Flu; the New Pandemic. Dr. Siegel is also the author of

"False Alarm: The Truth About the Epidemic of Fear"


"Bird Flu: Everything You Need to Know About the Next Pandemic."