Covering high-risk insurance pools: Victoria Colliver
The federal government and states are scrambling now to create temporary high-risk pools for the medically uninsurable by July 1. As one of the first provisions of the Patient Protection and Affordable Care Act to go into effect, it will serve as a test case for implementation of the new law and it should be closely followed.
Some states with existing high risk pools are passing laws to ensure their programs comply with the new federal rules and are eligible for some of the $5 billion in federal funding. Other states are refusing to alter their programs and ceding responsibility to the federal government. But apart from being a policy story, it’s of great interest to all your readers, viewers or listeners who have pre-existing conditions and are struggling to find coverage.
AHCJ has asked some reporters covering the topic for story tips, suggestions and resources. We expect to add more tips and resources to this package as the story develops. If you have something to contribute, please send it to firstname.lastname@example.org.
By Victoria Colliver
San Francisco Chronicle
Here's what we know: The states had until April 30 to tell the federal government how they intend to comply and whether they would run the pools at the state level or rely on a national pool to cover the medically uninsurable. So far, about 30 states and the District of Columbia have said they would run their own pools under the national guidelines and 19 said they would leave that up to the federal government.
Find out what your state decided (and why) and learn about your state's existing pool (if it has one). Don't assume the states that decided against running their own pool did so to make a statement against the health overhaul law.
Chances are your state already has a high-risk pool because about 35 states have them.You should get to know who manages that pool because that person and/or members of the advisory board will likely be instrumental in this transition. Some questions to ask and issues to look at:
- What's the next step your state is taking?
- How much of the $5 billion in federal funds will your state get? (This information is available through the U.S. Department of Health and Human Services).
- Will that funding be adequate or does your state think it will be on the hook for more money?
- Figure out how your state pool differs from the national pool. This is important because it could highlight potential inequities between the two pools.
- What are some of the restrictions in your state’s existing high-risk pool?
- How is it funded and how many people does it cover?
- Does it seem more or less consumer friendly than the national pool? In California, for example, there are pros and cons of each. The main advantage of the national pool is that it will likely offer lower premiums.
- How will the existence of a new pool affect people in the current pool?
Find people who are already in the state high-risk pool or are medically uninsurable and will benefit from the new pool. I've already collected people for my next story on this issue because I had a tricky time finding them for earlier stories.That's partly because California’s existing high-risk pool is relatively small and people are sensitive about being considered "medically uninsurable." Most of my people e-mailed me in response to other stories, so make sure to comb through your e-mails, but also work through advocacy and disease groups to find people who may benefit from the new pool. Their stories are key to making any story featuring the unfortunate term "high-risk pool" interesting.
Know what we don’t know: We still have more questions than answers. We don’t know how many additional people will be covered under the expansion and we need details on the benefit structure and exactly how much the national pool coverage will cost. States talk regularly with HHS, but are waiting for additional guidance. The answers to all these questions will make for good stories.