PA will manage a high-risk pool

Coming soon: Insurance options for people with pre-existing conditions

States are facing one of the first deadlines of the new health care law. Governors have until April 30th to say if they plan to establish a state-run, federally funded program to help sick people pay for health insurance.

Some states are hesitating but Pennsylvania’s health reform chief says the Commonwealth will establish a temporary high-risk pool. The pool would cover uninsured people who’ve been denied coverage because of a health condition or those who have been offered an unaffordable plan.

Only people who’ve been without insurance for six months qualify, but attorney Kristen Dama and other advocates are pressing federal officials to soften that rule.

Dama works for Community Legal Services in Philadelphia.

Dama: As it’s written the high-risk pool bill does not have any exceptions built into it. It says if you lose Medicaid, you have to wait six months, you lose AdultBasic, you have to wait six months. You lose crappy private insurance that you don’t want anymore because it doesn’t cover anything, you have to wait six months.

Enrollees will pay standard insurance rates for their region, and there’s a cap on out-of-pocket expenses. Federal dollars will pay the difference between each person’s premium and the true cost.

The Commonwealth will get about $160 million to manage the program for three and a half years until other health-law provisions begin.

Experts don’t expect the money to stretch very far. More than 30 states already have a high-risk pool and most have had to limit enrollment.

Sharon Ward is a leader in the Pennsylvania Health Access Network coalition. She has other worries.

Ward: High-risk pools benefit insurance companies. It enables them to move some of their sickest people from private coverage to publicly subsidized coverage, so we are concerned about that happening.

If states decide not to create their own high-risk pool, they can transfer the responsibility to the federal government. Several governors say they’re worried the program will become an unfunded mandate and they’ll be left to shoulder the cost.