Pre-Existing Conditions And Coverage

With the introduction of the Senate Finance Committee’s health care plan, a glimmer hope has been rekindled for those American who have been turned down for health insurance because of pre-existing conditions.

In fact, they could be eligible for coverage in a high-risk insurance pool that would accept anyone regardless of health condition.

In theory, it sounds very good. Yet, there are a few things to point out. A number of experts say that the high-risks pools currently in use in 35 states are being undermined by high costs and insufficient coverage.

Current plans suggest that the pool could be in place in 2010 and could remain operations for three years, or until the regular health insurance exchanges are in place. At that point, a high-risk pool would no longer be necessary since using the exchanges would be mandatory for all customers.

Still, many details have not been finalized. The state high-risk pools are typically managed by state-created non-profit organizations, which are funded via assessments on insurance companies or state funds. These non-profit groups would contract with heath insurance companies to maintain the day-to-day functions of the pool program.

At present, there are about 200,000 people enrolled in the high-risk pools, yet critics believe that there would be more people using them if they provided comprehensive coverage at more affordable prices.

Most states have established premiums at 150% of a standard individual plan statewide. In some areas, the policies cost more. The majority of these policies come with lifetime caps on benefits. Many are under $1 million. Others also include annual caps.

The question of whether a national high-risk pool could be conceivably adapted to the national level is prompting new debate. This concept would provide coverage in those states that do not have high-risk pools currently. Yet, the challenges inherent in establishing such a national pool cannot be understated.