High-risk pools include people who would otherwise be uninsurable because of pre-existing conditions. The proposed bill would offer $50 million for seed grants to assist states in setting up high-risk pools. Additionally, states would receive $2.5 billion annually over a 10-year period to fund these pools.
Here are five things to know about high-risk pools.
1. Before ACA implementation, 35 states had high-risk pools for non-group health insurance. In 1976, Minnesota and Connecticut established the first high-risk pools.
2. People were deemed eligible for high risk pools based on at least one of the following:
• Medical — People who could prove their applications for individual health plans had been denied or restricted, or if they had a diagnosed eligible condition.
• HIPAA — People who were HIPAA-eligible.
• HCTC — People who were eligible under the federal health coverage tax credit.
• Medicare — People who were Medicare-eligible and needed supplemental coverage.
3. By 2011, total enrollment in 35 state high-risk pools hit 226,615 people.
4. Even though every state high-risk pool encompassed different features, many shared these common aspects intended to cap eligible individual enrollment:
• Premiums higher than standard non-group market rates — All pools offered premiums between 150 percent and 200 percent higher than those rates in the non-group market.
• Pre-existing condition exclusions — Most pools did not cover pre-existing conditions for enrollees for between six months and 12 months, in order to stop those from enrolling purely for pre-existing conditions.
• Lifetime and annual limits — Many pools included lifetime dollar limits on covered services.
• High deductibles
5. The ACA established the Pre-Existing Condition Insurance Plan with different features:
• Premiums of 100 percent of the standard risk rate for non-group health insurance
• No annual or lifetime dollar limits on covered benefits
• No pre-existing condition exclusions
• Limited eligibility for individuals who were uninsured for at least six months before enrolling.
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