Penelope
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- Jul 15, 2014
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State High-Risk Pool Enrollment, Program Features, and Costs
Before HIPAA was enacted in 1996, there were 25 state high-risk pools with combined enrollment of 91,054.5 By the end of 2011, combined enrollment in 35 state high-risk pools reached 226,615. In four states (Maryland, Minnesota, Texas and Wisconsin) enrollment exceeded 20,000 individuals; in eleven states fewer than 2,000 individuals were enrolled. On average, state high-risk pool membership constituted about 2 percent of the number of non-group health insurance market participants that year.6 (Table 1)
Premiums above standard non-group market rates – All state high-risk pools set premiums at a multiple of standard (i.e., typical or average) rates for medically underwritten coverage in the non-group market; in most states the pool premium was capped at 150%-200% of market rates. Nineteen pools provided low-income premium subsidies that varied in comprehensiveness. The Oregon pool, for example, discounted premiums 95% for enrollees with income up to 185% of the poverty level, while the New Hampshire pool provided a 20% premium discount for enrollees with income below 200% FPL. 8 Other pools required people to pay the full premium, regardless of income.
Pre-existing condition exclusions – Nearly all state high-risk pools excluded coverage of pre-existing conditions for medically eligible enrollees, usually for 6-12 months. This made coverage less attractive for people who needed coverage specifically for their pre-existing conditions. In nine states, (CT, ID, MS, MO, MT, NC, OK, TX, and WY) the exclusion period was 12 months; in Colorado and Indiana it was 3 months. The Alabama pool, which was only open for HIPAA-eligible individuals, did not impose pre-existing condition exclusion periods.9
· Lifetime and annual limits – Thirty-three pools imposed lifetime dollar limits on covered services, most ranging from $1 million to $2 million. In addition, six pools imposed annual dollar limits on all covered services while 13 others imposed annual dollar limits on specific benefits such as prescription drugs, mental health treatment, or rehabilitation.10
· High deductibles – Most pools offered a choice of plan options with different deductibles; in 29 programs, the plan option with the highest enrollment had a deductible of $1,000 or higher; in ten states it was $5,000 or higher.
High-Risk Pools For Uninsurable Individuals - Issue Brief
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The AHCRA just goes back to the high risk pool plans of the states:
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Highlights:
Before HIPAA was enacted in 1996, there were 25 state high-risk pools with combined enrollment of 91,054.5 By the end of 2011, combined enrollment in 35 state high-risk pools reached 226,615. In four states (Maryland, Minnesota, Texas and Wisconsin) enrollment exceeded 20,000 individuals; in eleven states fewer than 2,000 individuals were enrolled. On average, state high-risk pool membership constituted about 2 percent of the number of non-group health insurance market participants that year.6 (Table 1)
Premiums above standard non-group market rates – All state high-risk pools set premiums at a multiple of standard (i.e., typical or average) rates for medically underwritten coverage in the non-group market; in most states the pool premium was capped at 150%-200% of market rates. Nineteen pools provided low-income premium subsidies that varied in comprehensiveness. The Oregon pool, for example, discounted premiums 95% for enrollees with income up to 185% of the poverty level, while the New Hampshire pool provided a 20% premium discount for enrollees with income below 200% FPL. 8 Other pools required people to pay the full premium, regardless of income.
Pre-existing condition exclusions – Nearly all state high-risk pools excluded coverage of pre-existing conditions for medically eligible enrollees, usually for 6-12 months. This made coverage less attractive for people who needed coverage specifically for their pre-existing conditions. In nine states, (CT, ID, MS, MO, MT, NC, OK, TX, and WY) the exclusion period was 12 months; in Colorado and Indiana it was 3 months. The Alabama pool, which was only open for HIPAA-eligible individuals, did not impose pre-existing condition exclusion periods.9
· Lifetime and annual limits – Thirty-three pools imposed lifetime dollar limits on covered services, most ranging from $1 million to $2 million. In addition, six pools imposed annual dollar limits on all covered services while 13 others imposed annual dollar limits on specific benefits such as prescription drugs, mental health treatment, or rehabilitation.10
· High deductibles – Most pools offered a choice of plan options with different deductibles; in 29 programs, the plan option with the highest enrollment had a deductible of $1,000 or higher; in ten states it was $5,000 or higher.
High-Risk Pools For Uninsurable Individuals - Issue Brief
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The AHCRA just goes back to the high risk pool plans of the states:
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Highlights:
- Fully Repeals Obamacare: AHCRA goes into effect on January 1, 2018 and fully repeals the president’s health care law.
- Increases Access to Affordable, Portable Health Insurance: AHCRA levels the playing field between people who receive their insurance through their employer and those who purchase it on the individual market by creating a standard deduction for health insurance. Under the RSC’s plan, individuals with qualifying insurance receive a $7,500 tax deduction and families receive a $20,500 deduction.
- Expands Insurance Access for Vulnerable Americans: AHCRA ensures those with pre-existing conditions have access to health insurance by expanding federal support for state high-risk pools and expanding portability so Americans can easily move between insurance markets without fear of discrimination based on health status.
- Spurs Competition Between Insurers: AHCRA allows people to shop for and purchase insurance plans across state lines, like other forms of insurance already allow. The plan also allows small businesses to pool together to negotiate for better rates.
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