By Justin Stoltzfus

Under the federal health care reform law, a new program is taking a page from auto insurance playbooks to fix a common health insurance problem for those with pre-existing conditions. In the past, many with serious health problems remained uninsured after getting rejected from private health insurance policies.  

A possible solution? The new national high-risk insurance pool. Like state-administered pools for drivers who have bad driving records, the health insurance pool guarantees coverage for those with medical conditions that make them too much of a risk for private insurers.

The Affordable Care Act, passed in March 2010, designated $5 billion in funding for the Pre-Existing Condition Insurance Plan, which will cover the formerly uninsurable until 2014. At that point, private insurers no longer will be allowed to reject applicants because of pre-existing conditions.

Before the law took effect, some states already had high-risk pools in place, contracting with private insurance companies to accept high-risk members. States administrated these pools, assigning different high-risk individuals to different companies to spread out the risk. Yet the state-run pools often had long waiting lists and high premiums.

The new health care law has given states a choice: They can operate their own pools with the help of federal funding, or they can hand the reins over completely to the federal government. Twenty-seven states have opted to run their own pools.
The emergence of a national high-risk pool is big news for anyone who has been previously denied coverage because of existing health issues. Some conditions do apply. According to a fact sheet from the U.S. Department of Health and Human Services, those who want to be insured under the program must meet the following conditions:

• Uninsured for six months before enrollment.
• Have a pre-existing condition that results in denial of coverage.

The Public Health Services Act dictates what constitutes one of these pre-existing conditions. Patients may be required to show proof of previous denial of coverage.
The cost of the joining the program varies state by state. Find premium and deductible information for your state at pcip.gov.

• In Pennsylvania, premiums will be $283.20 a month, with an in-network deductible of $1,000.
• California cites $575 as the monthly premium for a 50-year-old resident, with a $1,500 deductible.
• In Texas, premiums start at $174 and go up to $749 with a variety of deductibles and conditions.
• Florida has a similar setup, with a premium range of $196 to $650.
• New York cites premiums of $400 to $600 a month, with deductibles and details to be determined.
• Georgia’s program shows a premium range of $174 to $578.
• Illinois quotes premiums from $111 to $526 with a $2,000 deductible.
• Michigan’s premiums are yet to be determined.
• Ohio quotes premiums $189 to $545 for non-smoking residents, with a range of deductibles.