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Number of High-Risk Pool Participants Barely Increased This Summer

By Rebecca Adams, CQ HealthBeat Associate Editor

October 29, 2012 -- The number of patients in the high risk pool program authorized by the 2010 health care overhaul barely inched upward in August to 86,072 from 82,000 in July, according to the most recent estimates released this month.

The program is far below original enrollment expectations. About 9 million people in the United States have pre-existing conditions that might qualify them for the federal program if they meet other requirements. Actuaries had estimated that about 375,000 people would enroll during the first year of operation. The first pools started operating in July 2010.

The tiny uptick in enrollment in August was lower than it had been in some previous months. For a while—from August through November 2011—monthly enrollment rose to about 8,000 per month. But that didn't last.

On May 1, the Centers for Medicare and Medicaid Services (CMS) suspended an outreach program that provided $100 to insurance agents and brokers who referred patients to the program.

This summer, the number of patients did not dramatically increase. Enrollment through June 30 was 77,877 people.

Congress established the federally funded program—officially known as the Pre-Existing Condition Insurance Plan (PCIP)—in the 2010 health care law (PL 111-148, PL 111-152) as a way to help patients who couldn't find affordable coverage because of their medical conditions. Funding for the program is capped at $5 billion and expires on Dec. 31, 2013, just before the new insurance exchanges that will insure those people now covered in the pools are scheduled to open.

The federal government or states run the high risk program. The federal government runs pools in 23 states and the District of Columbia while 27 states have chosen to run their own programs.

The federally funded program sits alongside separate state-run programs that already existed in 35 states. But those existing state programs have different rules and are funded only by the states.

One reason why enrollment is lower than anticipated is that the federally authorized program requires people to be without insurance for six months. The per-patient costs of the program are also higher than expected however, because the program is attracting patients with very high medical costs. Federal officials had said in the past that on average, claims for the program have cost 2.5 times more than anticipated.

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