Health bill would offer high-risk pool

Gregory Warner Dec 24, 2009

Health bill would offer high-risk pool

Gregory Warner Dec 24, 2009


Kai Ryssdal: The Senate did two things before it took off for its holiday recess this morning. It raised the debt ceiling by $290 billion. That’ll let the government finance our deficit for about another two months or so.

Also, there was that health care thing, which really means that we’re going to spend another month or so talking about it while the House and Senate reconcile their different versions of the bill. A lot of the details are going to change. And a lot of its major provisions won’t take effect for a while. But some parts should take effect as soon as it becomes law. One of which could help unstick the economy, if it works. From the Marketplace Health Desk at WHYY in Philadelphia, Gregory Warner reports.

GREGORY WARNER: It was the end of another day at his corporate job when Matthew Blevins, a self-described computer geek in northern Virginia, sat down with his fiancee at the kitchen table and wrote The List: “Top 10 reasons stopping me from starting my own business.” Number one was the recession.

MATTHEW BLEVINS: Number two on the list of things was like, we don’t have any health care. And December of last year I was diagnosed with diabetes.

So Blevins stayed in his job for the health benefits. One immediate effect of a health care bill might be to let people with pre-existing conditions afford private health insurance. Injecting more mobility into the labor force. The Senate bill sets up a $5 billion fund — called a high-risk pool — to subsidize people who want to buy a policy but can’t find an insurance company to sell one to them.

SANDRA SHEWRY: Uninsurables. The uninsurables who had resources to buy.

Sandra Shewry has been thinking about this group for a while. She founded a state high-risk pool in California in 1990 and ran it for 12 years. Most of the people they helped were the self-employed. The problem was there was always a waiting list.

SHEWRY: Oh, it was heart-breaking. At some point the waiting lists were several thousand people in which case we didn’t close the waiting list, but it stopped growing because I think people understood that there was no reason to be on the waiting list when it was that long.

A high-risk pool is by definition a money loser. The government covers the people that insurance companies won’t touch. The federal program is just a temporary Band-Aid.

RICK CURTIS: It’s a complicated Band-Aid; it’s got arms and legs and holes in it.

Rick Curtis with the Institute for Health Policy Solutions in Washington says he expects this program to run into the same problems as California’s did: Waiting lists. Tight restrictions on eligibility. State officials worry the states will end up paying. Curtis says it lets insurance companies off the hook.

CURTIS: Insurers still don’t have to take the high-risk, and we’ll take the high-risk and then you have to pay for it with tax revenues.

Blevins, the computer geek, is optimistic.

BLEVINS: That’s kind of like the killer app for the United States. It makes me happy.

Georgetown professor Karen Pollitz, an expert on high-risk pools, says it’ll be a lifesaver for some.

KAREN POLLITZ: I would definitely keep an eye on the program and when it opens up, if you think you’re interested, get your application in early.

In Philadelphia, I’m Gregory Warner, for Marketplace.

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