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High-Risk Pools: Slow Start To New Program To Help The Uninsurable

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For the past six months, Mary Duffy of Redwood City, Calif. has eagerly awaited news about how to apply for a program created by the health care reform bill that will allow her to buy health insurance. So far, she's waited in vain.

"Every week for the last month I've been thinking, 'God, surely they'll have something out by June 1,'" said Duffy, a 60-year-old three-time cancer survivor. "It's been difficult because I've still been ordering medications from Canada."

Duffy has been uninsured since December because of her previous cancer. The health care reform bill signed into law on March 23 called for the creation of a $5 billion "high-risk pool" to cover people who are uninsurable due to preexisting conditions. The program would last until 2014, when an "exchange" will be set up for people to choose from a range of newly-affordable policies.

"Not later than 90 days after the date of enactment of this Act," says the bill, "the Secretary shall establish a temporary high risk health insurance pool program to provide health insurance coverage for eligible individuals during the period beginning on the date on which such program is established and ending on January 1, 2014."

Republicans have harped on the Obama administration for missing the 90-day deadline, which passed last week. Sen. Mike Enzi (R-Wyo.), ranking member of the Senate health committee, sent a letter to HHS secretary Kathleen Sebelius expressing disappointment in the administrations' "failure or inability to meet this important deadline for providing health insurance benefits to individuals with preexisting conditions." Enzi's letter, signed by 30 other Republican senators, asked the administration to state when money will be delivered to states and how many people will get help.

The Department of Health and Human Services has said the program will be "be available beginning on July 1" -- Thursday, the start of many state fiscal years -- and that insurance coverage could be available as soon as August. The program is federally-funded and will be run in each state either by the state or federal government.

Duffy has searched the websites for the Department of Health and Human Services and the California Managed Risk Medical Insurance Board -- the state's preexisting high-risk pool -- but has not found any new announcements about how to apply. The HHS website has a few basic facts making it clear to Duffy that she would be eligible for the program: She's a U.S. citizen, she has a preexisting condition, and she's been without coverage for the past six months. (The six-month wait time will essentially trap people enrolled in the more expensive state plans.)

HHS did not respond to repeated requests for comment about pool plans from HuffPost.

The nonpartisan Congressional Budget Office has estimated that $5 billion is not enough to cover all the eligible people who would apply for the program, and that the administration would have to limit enrollment to only 200,000 people through 2013, though there are roughly four million uninsured due to preexisting conditions. If the administration used more than $5 billion, the CBO estimated that the pools, which are supposed to cover "not less" than 65 percent of a person's health care costs, could reach 700,000 people at a cost of $15 billion.

Thirty-five states run their own high-risk pools, which are generally regarded as not terribly effective, covering only 200,000 people at above-market rates and often excluding coverage of certain conditions. The federal high-risk pool is supposed to be better and less expensive for policyholders. For instance, a fact sheet (PDF) from the California government lays out several ways in which the federal pool will be more liberal than the local version. But the state was still soliciting help for its high risk pool as recently as June 25. Duffy doesn't know how to apply and is skeptical the program will be ready.

"We need hard information at this point," she said. "This is June 28 and people are waiting to get insurance. The bottom line is, I don't see anything that tells me they're going to."

UPDATE: JUNE 29, 2010

HHS spokeswoman Jessica Santillo told HuffPost:

"The Pre-existing Condition Insurance Plan is a transitional program that helps to build a bridge to 2014 when insurers will be banned from discriminating against adults with pre-existing conditions and Americans who need health insurance will be able to access affordable coverage through the new health insurance exchanges. On July 1, HHS is launching a new web portal - www.healthcare.gov - containing a catalog of both public and private insurance options, assembled in one place for consumers. These include Medicaid programs, Children's Health Insurance Programs, Pre-existing Condition Insurance Plans, and private insurance plans supplied by more than 1,000 insurance carriers across the country.

In states participating in the national Pre-existing Condition Insurance Plan, on-line applications will be available starting July 1, with coverage beginning August 1 for those who apply by July 15. For states like California that will be running their own Pre-existing Condition Insurance Plan, application details and enrollment dates will vary. Starting July 1, Californians can visit www.healthcare.gov to find out more information on the new program."

Lucia Graves contributed reporting.

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