Covering high-risk insurance pools: Sarah Varney
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 email@example.com.
By Sarah Varney
KQED Public Radio and The California Report
Some stories to think about:
• Talk to your state insurance commissioner and state Medicaid administrators to understand how (or if) they’re planning on offering coverage.
• How do the new rules differ from the existing program, if there is one?
• Who will continue to be excluded and what options, if any, do they have before the exchange begins in 2014?
• What happens to people in the existing high-risk programs? They have not technically been uninsured for six months and don’t qualify under the new federal provisions, and the coverage they receive is generally much more expensive and skimpier than what the new enrollees will have. How will these disparities be reconciled?
Once the coverage kicks in this summer, it will be interesting to examine how well the program is administered (at the state and federal levels). For some of these people it will be the first time they have health insurance.
- How does that affect them, personally and professionally?
- What does it mean for their family members?
- Many of these people will have significant health problems. Will the $5 billion set aside in health reform be enough to cover the bill?
You might consider looking at access to care for those in the high risk pools. Many states contract out their high risk pools to private insurance companies who are supposed to have provider networks that are robust enough to handle the patient load (again, this varies state to state). How quickly are these people being seen? Are there enough specialists to handle what are likely to be complex health problems?
And finally, you might consider looking at the affordability of the coverage. The health reform bill caps how much individuals and families have to pay for coverage, but it’s likely still going to be too high for many people.