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Tip Sheets

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

By Sarah Varney
KQED Public Radio and The California Report

Covering high-risk pools

Tips from Victoria Colliver, San Francisco Chronicle

Tips from Sarah Varney, KQED Public Radio and The California Report

Tips from Dave Hage, Minneapolis Star Tribune

Tips from Mike Shields, Kansas Health Institute News Service

In an earlier feature on covering health reform, four journalists on the front lines offered their advice and suggestions on what needs to be covered next and how to approach this complex topic.

Recent coverage

Reform could mean end to state health care pool, Chen May Yee, Star Tribune  

$5 Billion In Federal Funding For High-Risk Pools May Not Be Enough, Christopher Weaver, Kaiser Heatlh News 

Health Reform Gets a High-Risk First Test, Evan George, Los Angeles Daily Journal (PDF posted with the permission of Daily Journal Corp. 2010)

New Health Law Expands High-Risk Coverage, Sarah Varney, KQED/The California Report

Health reform may alter high-risk pools, Victoria Colliver, San Francisco Chronicle

Governor vows to implement health care reforms, Victoria Colliver, San Francisco Chronicle

California gung ho on health care law, Carolyn Lochhead, San Francisco Chronicle

States begin considering high-risk pool provisions of health reform, Mike Shields, KHI News Service 

High-risk patients may be stuck paying high rates, Carla Johnson, AP medical writer

States Must Decide On Joining High-Risk Pools, Julie Rovner, NPR

McCain's Health Plan Focuses On High-Risk Pools, Julie Rovner, NPR

States Must Decide On Joining High-Risk Pools , Julie Rovner, NPR

The First Test Of New Health Law: Covering Hard-To-Insure People, Mary Agnes Carey, Kaiser Health News

Health-care law will alter high-risk pool, but just how hasn't been worked out, Carol Ostrom, The Seattle Times

State OK's fed health plan for those in high-risk pool, Carol Ostrom, The Seattle Times


Department of Health and Human Services: Next Steps in High-Risk Pool Program

Kaiser Family Foundation
State High Risk Pool Programs and Enrollment, December 2008
Fact sheet on the temporary federal high-risk pool

National Conference of State Legislatures

National Association of Health Underwriters

National Association of State Comprehensive Health Insurance Plans

National Association of Insurance Commissioners

Sarah Varney
Sarah Varney

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.