Status Update on Reform Law’s Temporary High Risk Pools

The SCOTUS announced yesterday that it will not fast track a Virginia appeals court ruling on the unconstitutionality of the reform law regarding its mandate on individual coverage. One year later, another provision of the ACA — the earmark of government funds (approx. $5B) to set up high-risk pools — continues to enroll healthcare consumers, but not exactly at a breakneck pace.

Previous to President Obama’s signing of the reform bill into law, those with high-risk conditions were flat-out rejected for coverage and had to search for alternative means to pay for care (Medicaid, OOP expenses). With the law’s provision in place, those who are able to qualify for such pools are having a much easier go of things, but are running into roadblocks — many of them political.

In (mainly red) states where governors may not support the reform law on constitutional grounds, the adoption rate is much lower among potential policyholders. In many liberal strongholds, however, PR surrounding the availability of pools is benefiting heavily from support of those (mainly blue) states’ chief executives and positive word of mouth. Since high risk pools are run by private insurers, premiums can also be a barrier to entry for many potential healthcare consumers, as well.

In spite of more aggressive awareness campaigns, development of more coverage options, and lowering of drug copays, enrollment in these pools still remains awfully low. As the Republicans begin to make this issue one of rejection by the American people on the subject of reform, Obama should give serious thought to on how best to move this provision forward. Twenty-fourteen^[1] is still quite a ways away. | LINK

After 2014, insurers will be barred from denying coverage on the basis of pre-existing conditions and federal subsidies will help low- and middle-income people buy insurance.