As part of the new health care reform, the federal government and 27 state governments are establishing temporary high-risk pools to offer coverage for people with pre-existing conditions until the law takes full effect in 2014. The effort has gotten off to a slow start, and Republican critics have, predictably, seized on that as “proof” that the government will be incapable of managing the much more complex changes lying ahead.
Initially, the concern was that the $5 billion allocated to lower premiums in the pools would not be enough to cover all of the people expected to apply after being denied commercial coverage because of costly conditions like cancer or multiple chronic illnesses. The Congressional Budget Office thought that 200,000 a year might enroll; the chief actuary for Medicare and Medicaid estimated 375,000 would enroll the first year. Experts estimate that a few million people are potentially eligible.
Six months after the plans started accepting applicants, only 12,000 people have signed up and the opposite concern has emerged — that the pools will fail to serve the needs of some very sick people.
Time for a reality check. It takes time to start any new program and enrollments grew slowly because — even with premiums brought down to levels that individuals without pre-existing conditions would pay — the price remained out of reach for many people.
Applicants also had to be uninsured for six months before they became eligible. Some 200,000 people remain enrolled in 35 state high-risk pools that existed before reform was enacted. While the premiums in the new pools are generally lower, most people will probably stay put rather than drop out for six months to be able to qualify.
The Department of Health and Human Services made sensible changes late last year. It lowered premiums by 20 percent in the standard plan, reduced the deductible for drugs and offered two more coverage options. It has also become more aggressive about informing people that they may be eligible. Enrollment has increased by 50 percent since Nov. 1, but the numbers are still very low.
House Republicans are preparing to investigate the program with an implication that sluggish enrollment may show that the public is unwilling to embrace reform. That’s really a stretch. Congress and the Obama administration should certainly identify reasons for the slow start and think about how to move the program forward.
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. There should be no question that full reform is the best long-term solution to the problem of covering our sickest citizens.
