Some Republican States Opting Out Of High Risk Health Insurance Pools

News outlets covered state responses to the federal government's deadline on high risk insurance pools.

The Miami Herald reports: "Gov. Charlie Crist will leave it to the Obama administration to run the federally subsidized high-risk health insurance plan that is to cover people unable to buy such insurance in the private market due to preexisting conditions such as cancer or diabetes.  In a letter late Friday to Health and Human Services Secretary Kathleen Sebelius, Crist said he agreed that states and the federal government must cooperate in expanding healthcare for Americans but said 'unfortunately Florida is not in a position to authorize new financial obligations'" (Tasker, 5/2).

The Cleveland Plain Dealer reports: "Ohio's Democratic governor wants to use the nation's new health reform law to soon help residents with diabetes, cancer and other pre-existing conditions get insurance if they have been rejected or cannot afford it in the private market. But it's too soon for patients to know what Gov. Ted Strickland's new program will look like, although he'd like to build on an existing private-sector program, with the potential for up to $152 million in help from Washington.
While facing a federal expectation to start such programs on July 1, state officials say they need guidance from the U.S. Department of Health and Human Services before deciding on specifics. And Strickland's plans would be likely to face political challenges" (Koff, 5/2).

Los Angeles Times: "As many as 20 states probably will not operate new insurance programs for Americans who have been denied health coverage, forcing the federal government to step in to implement one of the key elements of the healthcare overhaul legislation, according to administration officials. ... a succession of mostly Republican state officials has been rejecting the idea of creating state pools, voicing concerns that state governments would end up having to pay some of the costs of operating them over the next 3 1/2 years."

"By Friday afternoon, a deadline set by Sebelius, 15 states had informed the Department of Health and Human Services that they would not set up new pools, including South Carolina, Minnesota and Wyoming. Twenty-eight states, including California, New York and Illinois, indicated they would set up their own pools" (Levey, 5/1). 

CQ HealthBeat: "As of 12:30 p.m. Friday, these are the states that will operate a program: Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Illinois, Kansas, Kentucky, Maine, Maryland, Michigan, Missouri, Montana, New Jersey, North Carolina, Ohio, Oklahoma, Rhode Island, South Dakota, Vermont and Washington. States opting out are Georgia, Hawaii, Idaho, Indiana, Louisiana, Minnesota, Mississippi, Nebraska, Nevada, Tennessee and Wyoming" (Norman, 4/30).

MedPage Today: "The law provides $5 billion to fund the program from July 1, 2010 through Jan. 1, 2014. Money will be allocated based on each state's population as well as its costs. Many states already have such high-risk pools, although in some states, the pools might be more expensive for patients than the HHS-directed pools would be" (Walker, 4/29).

The Wall Street Journal: "The decisions on high-risk pools illustrate the pitfalls for the White House in handing states significant responsibility for carrying out the overhaul. In an effort to provide flexibility, lawmakers gave states oversight for some of the bill's biggest provisions, including running insurance exchanges starting in 2014 that will eventually cover about 30 million people. ... More broadly, the challenge for the White House is that 50 states could have 50 approaches, making the success of the health overhaul vary depending on where people live" (Adamy, 5/1).

Detroit Free Press: "Michigan will create a high-risk pool later this year to provide insurance for uninsured people with chronic health problems, most likely by subcontracting the job to one of the state's health insurers, state officials said Friday."

"Ken Ross, Michigan's commissioner of the Office of Financial and Insurance Regulation, said the state wants to create such a pool, which would provide affordable coverage to people who have been denied insurance for at least six months because they have a chronic health problem" (Anstett, 4/30).

Des Moines Register: "Iowa will use $35 million from the federal government to set up a temporary health-insurance pool ... [Democratic] Gov. Chet Culver decided to accept the money after receiving advice from the Iowa Insurance Commission. ... The Insurance Commission now must set details of how it will run the new pool, which will start July 1. Iowa is one of 35 states that already have similar programs. The one here is called the Health Insurance Plan of Iowa, better known as 'HIP Iowa.' It has about 3,000 members, most of whom have serious medical conditions, such as kidney disease, cancer or hemophilia (Leys, 4/30). 

Associated Press/CNBC reports that South Carolina Gov. Mark Sanford said "There's going to be somebody holding the bag for either one or two years worth of this program. … I don't think, as a fiduciary to South Carolina taxpayers, you want to put South Carolina in the role of the guy or the gal that picks up the bag" (4/30).

Associated Press/WKBT: "Gov. Tim Pawlenty says Minnesota is opting out of a new national high-risk pool for hard-to-insure Minnesotans. Pawlenty says Minnesota already has such a pool. And he's concerned that the initial $5 billion in federal funding for the program will go quickly, meaning big premium increases" (4/30).

The Seattle Times: "Washington state will administer an interim federal insurance plan for people with serious health problems, despite already having a similar statewide high-risk pool plan in place." Washington and other states "have struggled with the complexities of having to administer two plans that appear to target the same people, but have different qualifications, premium structures and possibly benefits" (Ostrom, 4/29).

Southern California Public Radio: "The federal government offered states a choice: let Uncle Sam run a temporary insurance program for people with serious medical problems who can’t get insurance — or let us pay you to do it. Governor Schwarzenegger chose the money: $761 million a year until the program dissolves four years from now.  … The state will run the federal program alongside a high-risk insurance program the state already operates for about 7,000 Californians, only the feds program will cover a lot more people — as many as 25,000 Californians" (Small, 4/29).

Meanwhile, late Friday, HHS Acting Assistant Secretary for Public Affairs Jenny Backus released this statement

"We are gratified by the response we have seen from the states regarding this important provision of the Affordable Care Act and look forward to working together to provide people who have been denied coverage for so long, access to some much needed relief through the creation of temporary high-risk pools. Whether states create these pools or the federal government creates them for states, the pools will be paid for by 100 percent federal dollars and most importantly --- uninsured people around the country will soon have access to another affordable coverage option."

“We value the input of our state partners and are heartened by the strong show of support we have seen already for getting the critical benefits of the Affordable Care Act to the American people as quickly as possible. This is a very state-friendly law that is designed to give states the resources and flexibility they need to implement its provisions. We will work closely with the states in the coming weeks and months to help their residents - who have been denied coverage for too long - to finally have affordable options."  (4/30).

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