HHS outlines plans for staying within high-risk insurance pool budget

Health care experts of all stripes warned during the healthcare debate that $5 billion would likely not last until 2014. Millions of Americans cannot find affordable healthcare because of their pre-existing conditions, and that $5 billon would only cover a couple hundred thousand people, according to a recent study by the chief Medicare actuary.

Each state has a certain budget allocation for its pool, and the first step to stay under budget would be to shift money around between states that don't see a lot of applicants and those that do, said deputy director Richard Popper.

"If we have that situation where we have strong demand in one state and not as strong demand in another state, the secretary of HHS after a year or two has the authority to reallocate the funding," said Popper, who used to run Maryland's high-risk pool. "Along with that, we can work with the states to adjust their benefit structure, the deductibles, the co-pays, the overall plan structure to address some of those cost drivers, again to help the plan make it to 2014 when it will no longer be needed."

In addition, Popper said, many people won't be able to afford to participate in the program because premiums will range between about $140 and $900 a month, depending on applicants' age and where they live. HHS estimates that 200,000 or more people will be in the program at any one time. To be eligible, applicants have to be citizens or nationals of the United States, or be lawfully present; have a preexisting medical condition; and have been uninsured for at least six months before applying for the high-risk pool plan.

"There are going to be meaningful premiums that are going to be required to stay this plan —premiums in the hundreds of dollars every month," Popper said. "There are a significant number of people out there with pre-existing conditions who are uninsured, but a significant number of those people ... also have limited income. And some of them, while they may need this plan, the premiums may not be something they can afford.

"We have that to think about as well," he added. "But for those who can afford it, this is going to be a great, great plan."

And if it looks like too many people are signing up — states will get monthly updates on how many people they can cover with the money they have left — there's always the option of turning people down.

The bill "does give the secretary authority to limit enrollment in the plan ... nationally or on a state-by-state basis," Popper said. "So that is present, but at this point, we're starting with no one in the plan as of today ... so we don't see that happening anytime soon."