Enrollment in High-Risk Health Insurance Pools Still Below Expectations

Enrollment in the high-risk health insurance pools created under the health reform law has not reached expectations, with just 8,011 U.S. residents enrolled nationwide after two or three months of operation in most states, according to HHS, the New York Times reports.

Background on High-Risk Pools

The reform law established the pools, called the Pre-Existing Condition Insurance Plan, to provide coverage to individuals with pre-existing conditions prior to 2014, when private insurers are required to accept all applicants.

To qualify for PCIP, individuals must have been uninsured for at least six months and been denied insurance coverage because of a pre-existing condition (Sack, New York Times, 11/4).

In April, federal officials estimated that about 375,000 U.S. residents would gain coverage through the high-risk pools. Some experts questioned whether the $5 billion allocated to the program would be sufficient to cover those residents (California Healthline, 10/4).

In addition, a recent study by the Commonwealth Fund revealed that an estimated six million of the country's 50.7 million uninsured residents might be eligible for the new pools.

Enrollment Low

However, enrollment in most states as of Nov. 1 was below 10% of capacity. For example, 21 states have enrolled fewer than 50 residents and New York and Florida each have enrolled fewer than 300.

Administrators of the pools attribute low enrollment to several reasons:

  • Lack of awareness among a hard-to-reach target population;
  • A requirement that applicants be uninsured for at least six months; and
  • The high cost of premiums, despite being set at market rates.

HHS Response

Richard Popper, director of insurance programs at HHS, refused to say whether he was disappointed with enrollment rates. He said, "It takes a while for advocates and stakeholders to realize there's this new plan," adding, "We're delighted the program is out there and making a difference in people's lives and keeping people alive."

Meanwhile, HHS on Jan. 1 will begin to give consumers choices of different plans with different costs and deductibles, in hopes it will draw more interest (New York Times, 11/4).

Susan Beetham
Hatti true enough - but Risk Pools only going to be providing coverage to very sick people that can't get coverage otherwise. Traditional insurance has healthy people to make up the difference, however, as the cost increases the healthy and young are less inclined to pay their share so they also aren't offsetting the costs for the sick folks.
Melinda Taylor
WOW!!! First off R. Popper states he's "delighted the program is out there and MAKING A DIFFERENCE IN PEOPLE'S LIVES????" He is obviously sitting behind a big desk, shining with a pen in his hand making such ridiculous statements while he is insured for a very reasonable premium. But LOW ENROLLMENT is a NO BRAINER... these politicians need to stop thinking we are all idiots and state the TRUTH!! The HIGH RISK PREMIUMS ARE WAY ABOVE MARKET RATES AND NOT AFFORDABLE the exact words from Pres. Obama,... whom stated "QUALITY HEALTH CARE WITH AFFORDABLE RATES!"... Quite the opposite for those of us with Pre Existing conditions and even someone like my self that is healthy with the exception of sleeping on a C PAP for sleep apnea which could be cured by a surgery but we lost our insurance before it could be completed. So, I fall into this trap like the rest of us that don't waste our time filling out the App. that we CANNOT AFFORD. Thanks to the Greed in this COUNTRY or should I say State!
Lucy Snyder
I never had any type of catastrophic event, just the usual small things, like thyroiditis and a little bit of hypertension. Being btwn 55-65 puts me in a high risk category. Been turned down numerous times for pre-existing. One company accepted me, premium of $800 a month with a $3500 deductible. Cannot afford it. If it was $400/mo I'd sign up. I don't need it to be free, but $800 a month? The program is just not working for regular people. I don't know who it helps?
Hatti Hamlin
This points to the lurking elephant in the room--high insurance rates simply reflect high costs to provide health care. The fact that the state itself cannot offer what are considered affordable rates to people with preexisting conditions shows that insurance companies should not be blamed entirely for high premiums. If we want universal coverage, we have to be prepared for everyone--healthy and sick alike--to pay more for it, both in premiums and in taxpayer subsidies. The Tooth Fairy is dead!

to share your thoughts on this article.