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Please begin with an informative title:

Today I had the distinct displeasure of reading that the high risk insurance pools, the "insurance of last resort" which was set up as the part of the ACA to deal with people with Pre-Existing Conditions who had been denied access to other insurance,HAS BEEN CLOSED to new applicants.

And in addition to that, current enrollees will see a 50% increase in their out of pocket spending limit. From Kaiser:

Feds Increase Costs To High-Risk Pool Members

Please join me below to discuss the various ramifications of this decision.


You must enter an Intro for your Diary Entry between 300 and 1150 characters long (that's approximately 50-175 words without any html or formatting markup).

This closure of the pools to new applicants is literally a life and death issue. There will be people waking up TODAY who have lost their job and their insurance and have a pre-exisiting condition, or who will receive a diagnosis of a life threatening condition while they are currently uninsured. These people were without hope for the most part prior to the ACA being passed at getting coverage for their conditions. Their choices boiled down basically to ignoring their conditions and dying or spending to cover themselves until reaching poverty and Medicaid. The ACA high risk pools finally provided the long missing 3rd option of guaranteed coverage without bankruptcy being a pre-condition

The high risk pools were never perfect. They never covered the amount of people they could have, because they were still unaffordable for many. Even so, they did provided interim coverage for 130,000 people.

There was NEVER enough money allocated for the program. This is no surprise and was evident and obvious from the passage of the ACA. The following was written in 2010 as part of a study for the auto unions:

NIHCR: Health Coverage For The High Risk Uninsured: Policy Options For The Design Of The High Risk Pools

While as many as 5.6-million to 7-million Americans may qualify for the program, the $5 billion allocated over four years will allow coverage of only a small fraction of those in need, potentially as few as 200,000 people a year.
Again,  only 130,000 ever enrolled, a fraction of the fraction predicted ,and yet the money allocated is still used up.

From the Washington Post:
Funds run low for health insurance in state ‘high-risk pools’

Of the original $5 billion, about $2.36 billion remains available for the last three quarters of 2013 — enough only to continue coverage for those already in the pools, according to administration estimates.

The law gave states the option of either administering their pools directly or allowing federal authorities to operate them. In 27 states that have chosen direct management, applications for new enrollment can be accepted only through March 2. In 23 states and the District, where the pools are operated by the federal government, only applications received through Friday will be considered.


Asked why the administration has not requested additional money from Congress to keep the program open — admittedly a tough sell in the current political and budgetary environment — Cohen said, “My responsibility is to work with the appropriation we have.”

One of the cruelest and hardest to understand provisions in the ACA from its inception was the fact that the ban on discriminating against those with pre-existing conditions was pushed back for four years. That discrimination against those who are CURRENTLY ill was one of the major reasons we have millions of uninsured and was one of the primary reasons government intervention in the health insurance marketplace was required inthe first place . Despite that fact, our law was written as if to say, "we know it's wrong and immoral, but we're going to allow that wrong and immoral practice for four more years" instead of banning it outright from the getgo.

The ONLY thing that made the pushback of the PEC requirement for adults even marginally acceptable was the fact that the high risk pools were to fill the gap. And as I believe is evident, the high risk pools have pretty much failed miserably at fulfilling their mission, although I am sure the 130,000 who made use of them are grateful.

In my opinion, closing the high risk pools to new applicants and basically telling people to die or go bankrupt is unacceptable. As an interim solution I propose opening up Medicare to any and every person who is uninsured and has a PEC and allowing those people to privately enroll, regardless of their age, until the ACA and the exchanges are implemented. That actually was the better and more obvious solution to the high risk pools from the beginning.

If that is not possible, then yes, the Administration does have the responsibility to seek further funding for the pools despite the cynical assertion of the official above who disagrees. I happen to know for a fact that BILLIONS of dollars allocated to help underwater homeowners was never actually used, so I suspect the funds are available from those or similar sources.

I am constantly amazed that we will go to war everlasting and spend trillions of dollars without question to avenge the deaths of 3,000 people on 9/11 (and I am not diminshing those deaths or their incalculable loss) but at the same time we will let 40-50,000 Americans die annually from lack of healthcare through our collective benign neglect.

Extended (Optional)

Originally posted to Phoebe Loosinhouse on Sat Feb 16, 2013 at 08:20 AM PST.

Also republished by Healthcare Reform - We've Only Just Begun and Single Payer: The Fight for Medicare for All.

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