By Julian Pecquet - 05/01/10 04:17 PM EDT
The decision whether to operate their own high-risk pool for
sick people who can’t get insurance has become a highly politicized issue in
some states, with a number of Republican governors blasting the $5 billion set
aside for the provision as insufficient.
As of mid-day Friday, 21 states and the District of Columbia
had decided to run their own pool while 11 states had opted to let the federal
government take over. Of the latter, all have Republican administrations save
for Tennessee and Wyoming.
In an April 2 letter to governors and insurance commissioners, Health and Human Services (HHS) Secretary Kathleen Sebelius set an April 30 deadline for states to decide whether to run their own pool.
In states that choose not to run their own programs, the federal government will use their share to cover that state’s uninsured itself. HHS unveiled each state’s share of the $5 billion last week.
California would get the most, $761 million, while North
Dakota, Vermont and Wyoming would each get $8 million. The high-risk pools are
scheduled to begin operating July 1 and aim to cover sick people who can’t find
insurance until 2014, at which point the comprehensive health coverage provisions kick in.
A number of state officials and health experts expect that
the $5 billion will run out long before then, however, raising concerns that
states that choose to run their own pool will be forced to foot the bill until
2014 once the money runs out. Rick Foster, the chief actuary for the Centers
for Medicare and Medicaid Services, pointed out in an April 22 analysis of the
health reform law that “by 2011 and 2012 the initial $5 billion in federal
funding for this program would be exhausted, resulting in substantial premium
increases to sustain the program; we anticipate that such increases would limit
An insurance industry source told The Hill that health
plans are also concerned that states that choose to run their own pools could
raise taxes on insurance plans once they run out of money, potentially raising
premiums for everyone.
The squabble over the high-risk pool has become particularly heated in Nevada, where Senate Majority Leader Harry Reid (D) has begun to run on his healthcare record just as Gov. Jim Gibbons (R) on Wednesday called the $61 million set aside for his state “grossly inadequate.”
While Gibbons told Sebelius that Nevada’s share would only
cover 2,900 of the 100,000 or so Nevadans who may be eligible, Reid blasted
Gibbons’ decision not to run a state pool.
Other Republican governors have also been vocally critical.
In a letter sent to Sebelius Friday, Indiana Gov. Mitch Daniels (R) said he
couldn’t allow “exposing Indiana taxpayers to an open-ended and potentially
enormous new burden."
Meanwhile, Wyoming’s Democratic governor Dave Freudenthal opted for a more conciliatory tone in a letter he sent to Sebelius on Wednesday.
“I am aware that this allocation [of $8 million] is in
addition to the premiums paid by enrollees to the program; however, I still
worry that the allotted money may prove to be insufficient to fully operate
this program until 2014.”
Other state officials have embraced the opportunity to run
their own pools.
Asked about California’s commitment to running its own
high-risk pool during a press conference Thursday, the state's Health and Human Services
Secretary Kimberly Belshe called it a “great opportunity."
“We are confident,” Belshe said, “that working with the legislature and with
stakeholders we can make this expanded high-risk pool a reality for
Californians, tens of thousands who we think will be able to enroll as a result
of these federally funded planning, administration and coverage dollars.”
At the federal level, some Democratic lawmakers have also drawn
attention to the program and the money it means for their states.
Sen. Tom Harkin (D-Iowa) may have been the first lawmaker to
tout the $35 million set aside for his state.
“Health reform will offer coverage to thousands of Iowans who, until now, have been locked out of the system,” Harkin said in an April 22 statement. “Having a pre-existing condition, whether it was a congenital heart problem, diabetes, or even arthritis, often meant that basic healthcare was out of reach"
He added, “Every American family should have access to the affordable,
quality coverage they deserve and as these reforms take effect, we are moving
towards that goal.”
Democratic Sens. Chris Dodd has also highlighted that the
provision will benefit his state of Connecticut to the tune of $50 million.
Here’s the breakdown, as of mid-day Friday on states that
intend to operate their own high-risk pool program:
District of Columbia
States that have elected to have HHS run the high-risk pool program: