Immediate Reforms

By Frank Hagan | Related entries in Health Care

You can view the recently passed HR 3962, the “Affordable Health Care for America” act, at (PDF file). While there is still quite a bit of change anticipated before this bill is consolidated with the upcoming Senate effort, we can at least see the text of the current proposal.

The bill has several “immediate reforms” in Title 1 that are interesting. The first such reform is the “National High-Risk Pool” program described in Title 1 Section 101, a $5 billion dollar “temporary” program intended to bridge the gap until the “Health Insurance Exchange” program is implemented.

Many states have “high-risk pools” already, and HR 3962 builds on that idea.

So how does the “National High Risk Pool” work? Like many state programs, it prohibits denial of coverage for pre-existing conditions. The list of qualifications for enrollment seems daunting, but are mainly to limit participation to people who cannot obtain group health coverage and are not eligible for other subsidized programs such as Medicare. Because COBRA eligibility does not disqualify someone, people between jobs could take advantage of the pool.

It is the cost structure I find interesting. Monthly premiums cannot be greater than 125% of a similar private plan. Annual deductibles cannot exceed $1,500 per person, with “cost sharing” (co-pays, co-insurance, etc.) limited to $5,000 per year per person, or $10,000 per family. Not cheap. The intent seems to provide health insurance at about the same cost to those who have been denied coverage due to pre-existing conditions, or have lost their group insurance coverage.

And what if the money runs out? From page 24 and 25:

INSUFFICIENT FUNDS.—If the Secretary estimates for any fiscal year that the aggregate amounts available for payment of expenses of the high-risk pool will be less than the amount of the expenses, the Secretary shall make such adjustments as are necessary to eliminate such deficit, including reducing benefits, increasing premiums, or establishing waiting lists.

Wait, isn’t that what those evil health insurance companies do? Hey, everybody, jump into the Pool!

Cross-posted to

This entry was posted on Monday, November 9th, 2009 and is filed under Health Care. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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