|
A Reform Plans recap of Kaiser's Ask the Experts: High-Risk Pools, July 17, 2008
Presumptive Republican presidential nominee John McCain has identified state high-risk pools as a vehicle for health care reform. Kaisernetwork.org assembled experts in the area to discuss high-risk pools--how they currently function and how they might evolve.
On Kaiser's expert panel:
- Lesley Cummings, Executive Director, California Managed Risk Medical Insurance Board
- Karen Pollitz, Research Professor and Project Director, Georgetown Health Policy Institute
- Christina Nyquist, Managing Director, Office of Policy and Representation, Blue Cross Blue Shield Association
- Doug Stratton, Executive Director, Indiana Comprehensive Health Insurance Association, Chair, National Association of State Comprehensive Health Plans
The experts pointed to the upsides and the downsides of high-risk pools, which exist to provide coverage to those who have otherwise been unable to obtain insurance:
On the upside:
The pools provide a safety net without requiring another pool (the non-group pool of other individual buyers) to subsidize them (which, some experts say, is what would happen if the high-risk pool population were simply folded in to the general individual buyer population) and thus provide "life-saving coverage" to many people who wouldn't otherwise have it.
Within pools, states can explore case management options. Indiana's Doug Stratton notes that case management approaches for hemophilia saved the state some $9 million (roughly a 50% savings), for example.
On the downside:
Participating in the pools generally means paying a high, often prohibitively high, premium (in California, Lesley Cummings points out, high-risk pool enrollees making less than $20,000 spend 36% of their income on coverage) -- and that's if you can get in and get the coverage you need. The pools also feature waiting periods, exclusions based on pre-existing conditions, other eligibility restrictions, and annual and lifetime deductibles or caps. Subsidies are available but don't make the pools accessible to all. Thus, says Karen Pollitz, they "haven't reached most of the people that are unable to pass medical underwriting."
So, are pools the answer to extending health insurance to America's uninsured? Is McCain's plan to up their funding going to help? If so, how?
The panelists debated the merits of public versus private coverage and high-risk pools versus guaranteed issue. Christina Nyquist of the Blue Cross Blue Shield Association stressed that having a single guaranteed-issue pool would result in an upswing in premiums across the board, and others theorizing about other ways, via public or private coverage, to apply the subsidies that currently support (to some degree) high-risk pools. Asked Pollitz, "Are we about subsidizing or are we about protecting the profitability of the industry?"
Nonetheless, Stratton cautioned about "messing with the industry right now," citing the general economic downturn. He favors incremental change, as long as it eliminates barriers and costs.
Regardless of the overall approach to health care delivery and funding, clearly additional funds will help--indeed, "additional funding is absolutely essential," says Pollitz. Currently, the various state pools are funded using a federal grant pool, premiums, and state dollars (for example, from tobacco taxes). Panelists suggest that increased funds can be deployed to support various activities that would make high-risk pools a broader-based solution: expand subsidies for premiums, address the pre-existing condition exclusions, improve reporting and data gathering to reveal other solutions, and increase case management, particularly directed toward those health care conditions that drive most of the costs. Additionally, a look at pool governance is warranted.
The funding needs are substantial, though. As Pollitz put it, it's not a matter of funding a program on a shoestring; rather, "it's gonna take the whole shoe and then some."
(see kaisernetwork.org )
|
Features/Opinion 
