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.
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."