Temporary Federal High Risk Health Insurance Pool Program

Mark Newsom
Analyst in Health Care Financing

This report briefly describes the temporary federal high risk health insurance pool program established by the Patient Protection and Affordable Care Act (PPACA, P.L. 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, P.L. 111-152). Under PPACA, the federal high risk pool program is intended to help individuals with preexisting conditions who have been uninsured for six or more months to obtain health insurance coverage before 2014, when other relevant reforms take place. States can run the program or elect to have the Department of Health and Human Services operate the program in their state. 

To be a qualified high risk pool, the high insurance coverage must have an actuarial value (the average percentage of expenses that the plan would cover) of at least equal 65% of total allowed costs, and out-of-pocket costs cannot exceed $5,950 for an individual in 2010. The premiums must be established at a standard rate for a standard population, and age rating cannot exceed a factor of 4 to 1. Claims and administrative costs will be subsidized by the federal government. 

PPACA appropriates $5 billion of federal funds to support the program, available beginning on July 1, 2010, until the program ends on January 1, 2014. The Department of Health and Human Services has proposed allocating funds to states by using a combination of factors, including nonelderly population, nonelderly uninsured, and geographic cost as a guide, with the intention of reallocating funds based on actual enrollment and expenditure experiences. The Secretary of Health and Human Services may take any actions necessary to prevent deficits.


Date of Report: May 13, 2010
Number of Pages: 10
Order Number: R41235
Price: $29.95

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