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Thursday, February 3, 2011

Health Insurance: State High Risk Pools

Bernadette Fernandez
Specialist in Health Care Financing

In an effort to expand the options for health coverage, 35 states have established high risk health insurance pools. These programs target individuals who cannot obtain or afford health insurance in the private market, primarily because of preexisting health conditions. Also, many states use their high risk pools to comply with the portability and guaranteed availability provisions of the Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191).

In general, state high risk pools tend to enroll a small percentage of the uninsured. In December 2009, approximately 208,000 individuals were enrolled in high risk pools. State-established nonprofit organizations typically run these pools, with private insurance companies handling dayto- day operations, along with plan administrative staff. Although benefit packages vary across states and plans, they generally reflect health benefits that are available in the private insurance market. The majority of high risk pools cap premiums between 150% to 200% of market rates, and pools are subsidized through insurer assessments and other funding mechanisms.

The Trade Act of 2002 (P.L. 107-210) appropriated a total of $100 million for FY2003-FY2004. With the expiration of authorizing legislation for federal funding of state pools, the 109
th Congress took up this issue. The House passed H.R. 4519, the State High Risk Pool Funding Extension Act of 2006, which reauthorized federal grants to state high risk pools through FY2010, and changed the funding formula used for such grants. The Act authorized $15 million for seed grants and $75 million for operational and bonus grants for FY2006. The Senate passed H.R. 4519 without amendment, and it was signed into law (P.L. 109-172) on February 10, 2006.

As part of the budget reconciliation process, the Senate passed S. 1932, the Deficit Reduction Act of 2005 (DRA) conference agreement, which provided appropriations for the grants authorized under H.R. 4519. The measure also included conforming language on enactment of H.R. 4519. The House agreed to the Senate-amended DRA bill, and it was signed it into law (P.L. 109-171) on February 8, 2006. The Centers for Medicare and Medicaid Services (CMS) awarded grants to 31 states that experienced operational losses in 2005. Of those 31 states, 25 also received bonus grants. In 2006, CMS awarded seed grants to five states, and to another five states in 2007.

The 110
th Congress took up the issue of extending the federal grant program by making funding available pursuant to the Consolidated Appropriations Act of 2008 (P.L. 110-161). The grant funding totaled $49,127,000. In July 2008, CMS announced that 30 states received operational and bonus grants totaling $49,126,500.

The 111
th Congress provided $75,000,000 in appropriations for grants to state high risk pools under the Omnibus Appropriations Act of 2009 (P.L. 111-8). On September 30, 2009, CMS awarded operational grants to 31 states and bonus grants to 28 states. Furthermore, the Consolidated Appropriations Act of 2010 (P.L. 111-117) provided $55,000,000 in additional appropriations for high risk pools.

In addition to state-established high risk pools, the Patient Protection and Affordable Care Act (PPACA, P.L. 111-148), as amended, requires the Secretary of Health and Human Services to establish a temporary high risk pool program to provide health insurance coverage for certain uninsured individuals with preexisting health conditions.

Date of Report: January 26, 2011
Number of Pages: 16
Order Number: RL31745
Price: $29.95

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