government

Shortcomings of high-risk insurance pools cited

NEWS IN BRIEF — Posted Oct. 1, 2012

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State and federal efforts to provide temporary insurance solutions to individuals with preexisting conditions are useful to a point but offer no sustainable long-term coverage solutions, the Commonwealth Fund reported Sept. 13.

Starting in 2014, people with preexisting conditions no longer can be denied insurance coverage based on those conditions. Until that time, state high-risk pools as well as a federal program called the Pre-Existing Condition Insurance Plan exist as alternatives to help these types of individuals obtain interim coverage.

The Pre-Existing Condition Insurance Plan appears to be fulfilling its role as a “bridge” program, in particular for beneficiaries on the cusp of Medicare eligibility or young women with high-risk pregnancies, the report found. Nearly 78,000 people have enrolled in the federal plan since 2010, whereas some 226,000 are getting coverage through state-run high-risk pools, some of which have been in existence for decades.

These programs, however, have had relatively low enrollment and high costs, and often have been too expensive for many of those eligible to participate. The report’s authors noted that the federal plan appears to be drawing patients with high-cost medical conditions such as cancer.

The report indicated that the situation should improve in 2014 when subsidized coverage becomes available through health insurance exchanges, Medicaid eligibility expands and insurers no longer are allowed to deny coverage based on health history.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2012/10/01/gvbf1001.htm.

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