The Federal High-Risk Pool, set up for states that did not want to run their own pools using federal monies, has been taking applications since July 1st, and coverage is slated to start August 1.
Many to-be State-run pools have lagged behind, but a few industrious states have set up the neessary legislation, bureaucracy, infrastructure and web sites to allow them to begin taking applications.
Colorado, South Dakota and North Carolina (along with possibly other states) have their acts together and are already accepting applications (you can obtain lots of information about these states' programs and application forms at the above links).
Other states have been slower to act. For instance, Ohio
is currently analyzing the legislation and determining next steps so that Ohio takes full advantage of all of the opportunities that will benefit Ohioans
while Missouri claims that
Effective July 15, 2010, Missouri residents may apply for a new pool being operated by MHIP.
Most states that are still setting up their own plans hope to be taking applications in August with a goal of having coverage start by September 1.
Even given the provisions of federal law (the PPACA) and guidelines from HHS, so far each state has its own peculiarities when it comes to eligibility, and each state's premiums and plan structure are different.
For example, a 50-year old non-smoker in North Carolina eligible for their high-risk pool has options ranging from $469/month with $1000 deducible to $261/month with a $4500 deductible. In Colorado, however, a similar person is offered only one option: a single plan at $398/month with a $2500 deductible. South Dakota offers $456/month and a $2000 deductible.
In South Dakota (pdf), if you have Wilson's disease (whatever that is), you are automatically eligible for their high risk pool (no letter of denial from an insurance company is required, although you must have a South Dakota driver's license...). But in Colorado, Wilson's disease is not on the list of diseases that automatically qualify you (but it's okay if you don't have a driver's license; a tax return with a Colorado address, or a utility bill in your name will be sufficient).
(I wonder if it ever occurred to whomever set up the plan in South Dakota that someone who is seriously ill or has a disability might not have a driver's license?)
In Colorado (pdf), if you need an insurance company denial letter as proof that you are eligible, it must be dated within 60 days of the date the application is submitted (!). In North Carolina (pdf), the letter must be dated within six months of the date of the application. Another state's form which I no longer have the link to does not mention a date.
Colorado, South Dakota and North Carolina all demand that payment be made via automatic withdrawls from a bank account. Therefore if you don't have a bank account it will be impossible for you to obtain coverage. Colorado, at least, has a provision for using an account in another person's name, but that person must be a family member.
And so it goes. Thanks to Congress, instead of a single, nationwide high-risk pool with uniform application procedures and eligibility requirements, we've ended up with 30 different programs (29 state programs plus the federal one). If a person moves from one state to another, they will lose their enrollment and have to reapply in their new state (even if they move from one state to another that are both in the Federal program, if I understand correctly). And if enrollments are suspended in a particular state due to funds limitations, someone who moves could well find themselves frozen out. You could be eligible for the program in some state, but not in the one you happen to live in, due to how arcane details of the program differ from state to state.
Still, these high-risk pools will, within a month or two, be providing insurance coverage (and therefore medical treatment for those in need) to 100,000+ individuals who would otherwise not be able to obtain coverage at any price until 2014. And at a cost which, while high, is not any more (premium-wise, by law) than the average Jane or Joe is paying for coverage -- whereas previously established state high-risk pools typically have significantly higher premiums, making them completely unafforable to many people. For those who are eligible and can afford them premiums, deductibles and out-of-pockets (probably coming to between $7000 and $10000 a year, depending on age), this program will be huge peace-of-mind provider. No longer will those enrolled program have to worry about randomly occurring $20,000 or $100,000 medical bills for their illnesses, bankruptcy or other tragedies.
This is the first significant test of whether the Federal government can administer the new health care law. If the high-risk pools are up and operating smoothly, if the number or horror stories and SNAFUS is low (of course there are going to be some), if a good number of people who were actually going without treatment are now being cared for, then the administration will have a good case to put before the voters iby November. And if not, there will likely be hell Congressional seats to pay.