CAHI Issues: Health Insurance’s “High Risk” Pools

Health insurance risk pools are special programs created by state legislatures to provide a safety net for the “medically uninsurable” 1% to 2% of the population, who have been denied health insurance coverage because of a pre-existing health condition, or who can only access private coverage that is restricted or has extremely high rates.

Established over 25 years ago, high-risk pools operate in 33 states and covered more than 181,000 people as of June 2004, according to Communicating for Agriculture & the Self-Employed. In August 2002 the federal government approved funding of up to $1 million each for states that did not have a qualified high-risk pool as an incentive to establish them.

The Council for Affordable Health Insurance (CAHI) believes that state high-risk pools are a much better alternative to providing coverage for the medically uninsurable than imposing guaranteed issue laws on insurers which eventually increase the cost of insurance for everyone. (Guaranteed issue is a requirement that insurers in the individual market accept applicants regardless of their health status).

CAHI Solutions

Expanding and securing federal funding for state high risk pools is a critical component in CAHI’s fight against state guarantee issue and rate restriction provisions. In 2004, CAHI was instrumental in drafting legislative language in the House of Representatives and the U.S. Senate that would extend and expand federal operational grant money to state high risk pools. CAHI has led the way in developing grass roots support for the legislation.

H.R. 4519, the High-Risk Pool Funding Extension Act, which extends funding for the operation of state high risk health insurance pools, was signed into law on February 1, 2006 (P.L. 109-172). In H.R. 4519 seed grants were extended through FY06. Funding for the FY06 seed and operational grant funding was included in the Deficit Reduction Act of 2005 (DRA). Operational grant funding for FY2007 – FY2010 was authorized under P.L. 109-172, but not appropriated. The next challenge is securing FY07 funding through the Congressional appropriations process.

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