Mainstream media covered an interesting observation on the Affordable Care Act (ACA) recently regarding high-risk patient coverage. The part of the ACA that was enacted almost immediately this year was to provide access through high-risk pools for people who are too ill to easily obtain or afford health insurance. The pools were set up in about half the states pretty quickly (some already had such a pool); states that chose NOT to establish them could then refer residents in need to a back-up federal pool for coverage of states without their own special high-risk health plan. The high-risk pools were only to be needed until the ACA is fully implemented in 2014, when such patients will be covered in other ways, mainly through the proposed state exchanges. Twenty-three states and the back-up federal pool were in effect this past fall.

Republicans, insurers, state governments, and many policy observers predicted when the pools were established that the $5 billion that Congress has devoted to the program for the next 3 years was far too little money, and would run out way before 2014. But, here’s the surprise: hardly anybody is signing up! Last spring, Medicare program's chief actuary predicted that 375,000 people would sign up in 2010, but only 8,000 have enrolled nationwide (only Colorado's plan is close to its forecast enrollment for some reason).

Federal health officials contend that the new plans are just ‘experiencing expected growing pains,’ and will take time to let people know they exist and to get actuarial experience and data to adjust prices and benefits to be attractive. State directors of the pools in part agree, but say the premiums they must charge are unaffordable for most of the intended beneficiaries. They also blame the Republican threats to overturn the law or de-fund it as deterrents to people who would benefit, and people think they need to wait and see if these plans survive.

Some patients credit the new pools as already having saved their lives. Others say the premium costs are more than they could possibly afford, and are a big disappointment.

The feds will pump money into advertising this year to let people know the plans exist; and premiums are being adjusted downward to make them more affordable in many regions. If we build it will they come?  I wonder. What are your thoughts on the high-risk pools?

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