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First Test of HCR: High Risk Pools

Health Care Reform 2010 ObamaCare

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#1 QueenTiye

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Posted 28 March 2010 - 02:51 PM

http://www.kaiserhea...ance-pools.aspx

Quote

While 34 states currently operate such programs, called high-risk pools, some are closed to new entrants and most struggle to finance coverage for approximately 200,000 enrollees nationwide. Most tend to be sicker and older than the general population, and to qualify they must have been unable to obtain coverage through other sources.

About two million people might be eligible for the new pool, analysts predict, though how it would operate is unclear – complicating a daunting timetable for implementation.

The health care law President Barack Obama signed Tuesday offers only general guidance, making the Department of Health and Human Services responsible for creating the program. It would last until 2014 when health insurance exchanges, marketplaces where companies compete for business, are scheduled to be up and running.

While people will still have to pay premiums to buy coverage, the federal government will add $5 billion to pay claims. The law allows the secretary of HHS to administer the pool or contract it out to states or a non-profit entity. Under the new law:

* Applicants must be U.S. citizens who are not covered by another form of insurance, have been denied coverage due to a pre-existing condition and have been without health care coverage for at least six months.

* Older people can’t be charged more than four times younger ones.

* The plan must cover at least 65 percent of participants’ health costs and follow annual out-of-pocket limits set in the bill.

* Premiums will be based on "standard rates," which states define as average premiums charged by private insurers for similar coverage.


Quote

Some health care analysts wonder if HHS can pull off such a complex process of setting up a high-risk pool in just three months. "That doesn’t feel like a 90-day process. It will take a lot of work to get there. This is going to be a heavy lift," said Peter Harbage, a Democratic health policy consultant.

There’s speculation that several risk pools will result. "It is most likely there will be not one national program and that the secretary will go through a very quick bidding and contracting process to get national coverage through states and non-profit entities, but that’s a pretty short order in that amount of time," said Bonnie Washington, a vice president at the health care consulting firm Avalere Health.

The National Association of State Comprehensive Health Insurance Plans, a trade group representing state-run high-risk pools, has said that existing programs could be expanded quickly "with an infusion of relatively modest interim federal funding."

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#2 Zoxesyr

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Posted 28 March 2010 - 11:34 PM

The high risk pools won't be all that hard to figure out.  The HHS has a huge wealth of Medicare and Medicaid data to use, as well as actuarial data collected from insurance companies.  If they spread the risk across the entire US, rather than state-by-state, then they could might be able to get reasonable rates.

If they set up the bidding process by modeling it from the Medicare system, then that can be set up in 90 days.  However I wonder which companies will bid on the new benefits plans.
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#3 Palisades

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Posted 29 March 2010 - 11:45 AM

Quote

* Premiums will be based on "standard rates," which states define as average premiums charged by private insurers for similar coverage.

Does that mean what private insurers charge for similar benefits for a normal pool or what the private insurers would charge for a high-risk pool?

Edited by Palisade, 29 March 2010 - 11:46 AM.

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#4 Zoxesyr

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Posted 29 March 2010 - 08:08 PM

View PostPalisade, on Mar 29 2010, 05:45 PM, said:

Quote

* Premiums will be based on "standard rates," which states define as average premiums charged by private insurers for similar coverage.

Does that mean what private insurers charge for similar benefits for a normal pool or what the private insurers would charge for a high-risk pool?

unless clarified by further law, this means the standard charges for a similar high-risk pools with similar benefits that private insurers have in each state.

...does anyone else see the loophole now?  :lol:
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