A map of North America surrounded by a stethoscope, medicine capsules and medical syringe symbolizes health care reform in the U.S.
A map of North America surrounded by a stethoscope, medicine capsules and medical syringe symbolizes health care reform in the U.S. - 
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Tess Vigeland: Today marks one of the first deadlines in the new health insurance law. States have to decide whether to take federal money to run a new insurance pool for people with serious medical problems or to tell the feds to run it themselves. With few exceptions, the states were divided along party lines.

But as Marketplace's Gregory Warner reports from the Health Desk at WHYY in Philadelphia, there's a little bit more than politics involved.

Gregory Warner: Dick Netley is a structural engineer in Omaha. His daughter, Kristen, was born with severe respiratory problems. Her early care was more than insurance could pay for.

DICK NETLEY: She went through a million-dollar cap in about 19 months.

Kristen died eight years ago at age 13. Her father says if she had survived to adulthood...

NETLEY: She would have been uninsurable. No insurance company would have touched her.

Netley didn't want other families to have to worry about that, so he joined the board of Nebraska's high-risk pool. It's a state-subsidized insurance program for people that private insurers won't cover. High-risk pools are by definition money losers for states because the people in them are so sick. In 2014, when the health care exchanges kick in, all state high-risk pools will disappear.

JEANIE ESAJIAN: Preexisting conditions become a thing of the past. There will no longer be anyone who would be considered medically uninsurable.

Jeanie Esajian is a spokesperson for California's risk pool. Until 2014, she says, health care reform law will provide some temporary relief. It gives $5 billion to the states to help build up high-risk pool programs. States have until today to decide whether they will run the program with federal money or let the feds run the pool in their states.

CECIL BYKERK: They say let the feds do, OK. Well the feds are going to hire somebody to do it.

Cecil Bykerk is the executive director of high-risk pools in Iowa, Alaska and Montana. He says states that say no to the money will still get a high-risk pool. But the state government won't be the face of it. That could be the idea. Even these new high-risk pools are likely to have quotas and long waiting lists.

BYKERK: When the pool gets capped. And people can't get in. That guy's gonna be angry!

Bykerk says some states would rather that anger, when it comes, be directed at Washington.

In Philadelphia, I'm Gregory Warner for Marketplace.

Follow Gregory Warner at @radiogrego