Slow-Starting High Risk Pools Look For Bigger Wave Of Enrollees, Other Reform Issues

States have seen a "slow trickle" of enrollees for new federally funded high-risk pools but are expecting more to begin enrolling as word spreads about the coverage option, Politico reports. Only a handful of states have opened their operations already. "Representatives of these pools in Colorado, New Hampshire, New Mexico and North Carolina told POLITICO that while they are generally pleased with the enrollment process so far, they still harbor some concerns about outreach and affordability. Their offices have experienced a higher volume of calls and website traffic since the launch and hope the inquiries about the new program will soon translate into applications."

In all, 29 states have decided to run their own high-risk pools while the rest opted to let eligible residents join a federally run pool. Some state officials say they have doubts that the federal funding will last. "Congress allocated $5 billion to run these temporary pools until 2014, when insurers will be barred from denying coverage to individuals based on pre-existing conditions. To be eligible, individuals with pre-existing conditions must have been uninsured for at least six months and demonstrate that they have been denied coverage elsewhere." State officials said some who are enrolling are happy to have the coverage, but others say they cannot afford the premiums and deductibles in the plans (Park, 7/13).

The (Wilmington, Del.) News Journal: Delaware and several other states have handed responsibility for running the pools to the federal government. "Regardless of how costly their illnesses are, out-of-pocket costs each year — excluding premiums — will be limited to less than [$5,950] for individuals and under $12,000 for families. Premiums will be set as if for a standard population, rather than a population with a strong likelihood of costly health problems. Details have yet to be released." Delaware officials say their share of the federal funding is $13 million to cover 2,000 people. "Nationally, the $5 billion is expected to cover 300,000 people" (Ratnayake, 7/13).

USA Today: Meanwhile, finding insurance options got easier recently with the launch of healthcare.gov, where people can go to find coverage options. "If you're looking for an individual insurance policy, you'll be asked to provide your age, your state of residence, and whether you have a medical condition. Once you've done that, you'll get a list of plans available in your area. You'll get a summary of each plan's benefits, and you'll be able to find out whether your doctor is in the plan's network. What you won't get are prices: The site won't provide premium estimates until October. In the meantime, you'll have to contact the providers directly" (Block, 7/13). 

Nashville Business Journal: And a Nashville-based market research firm is examining a different part of the overhaul: how it will affect the country's largest managed health care organizations. "The National MCO Analyzer series launched today will profile the largest private health insurers, forecasting the year ahead; analyzing each MCO's strengths, challenges and opportunities; and provide national-enrollment mix and trends." The first report analyzed Humana (Wortham, 7/12). 

Kaiser Health News: A health overhaul demo program is enabling some older patients to get very specialized care. "In this era of assembly-line appointments, when you're lucky to get 10 minutes of face time with a physician, the idea of doctors making house calls seems old fashioned. But for frail, elderly people with multiple health problems, bringing the medical establishment to the patient makes sense. … The health care overhaul creates a three-year Medicare demonstration project to test the home visit concept on 10,000 of the sickest, most-expensive-to-treat Medicare enrollees. To be eligible for the project, called Independence at Home, patients must have multiple chronic conditions and be unable to perform normal daily activities like bathing and dressing. They must also have been hospitalized or needed other high-cost care in the last year" (Andrews, 7/13).

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