Skip to main content

Advanced Search

Advanced Search

Current Filters

Filter your query

Publication Types



Newsletter Article


HHS Officials Pushing High-Risk Pool Coverage After Cutting Premiums

By Rebecca Adams, CQ HealthBeat Associate Editor

January 20, 2011 -- Participation in high-risk pools created under the health care law doubled in the past month after HHS officials cut premiums, and those officials will begin a series of regional outreach events next week in an effort to build on that momentum.

The pools, known as the Pre-Existing Condition Insurance Plan, started this summer. Every state was required by the new health care law (PL 111-148, PL 111-152) to create a separate one funded by federal dollars for people who have not had insurance for at least six months because they have preexisting conditions. State officials can elect to run the pools themselves or allow the same company that runs the Federal Employment Health Benefits Program to operate them.

For months, state and federal officials were concerned because enrollment was lower than anticipated. Republicans criticized the lower-than-expected enrollment in the plans, saying that the new plans duplicate other existing state risk pools. While GOP lawmakers support the concept of high-risk pools, they say they would have structured them differently.

However, enrollment is growing now. Because the law requires that the premiums mirror standardized risk rates, HHS officials cut premiums this month and the number of applicants doubled.

Richard Popper, director of insurance programs at the HHS Office of Consumer Information and Insurance Oversight, said in an interview Thursday that he is pleased that collaborations with hospitals and patient organizations for certain diseases also are leading to higher enrollments in the risk pools. Some hospitals and disease groups are paying premiums for patients. (See related story.)

Popper said it was too early to tell how long federal funding for the pools will last. The new plans are financed through 2013 by about $5 billion in federal funds—an amount that the Congressional Budget Office has said previously would "not be sufficient to cover the costs of all applicants." Popper said that it would be hard to make predictions about funding because it is a new program and actuaries say that it's hard to project costs until there is a full year of experience to look back on.

Popper did say that some states were relieved when HHS officials wrote release valves into some state contracts, so that if a state hit an enrollment or cost threshold spelled out in the agreement, then the state would have a chance to change its policies for the pool.

That "triggers an immediate discussion where we either cap enrollment or take other steps, modify the benefits, to address that," Popper said. "That allayed a lot of concerns states had about money being exhausted."

Publication Details