Federal Deadline On State Health Insurance ‘Pools’ Sparks Confrontations, Triggers Decisions

States must tell the federal government whether they will help run new insurance pools for high-risk patients by Friday, which could set up political confrontations, The New York Times reports. "The fight over the new health care law shifted Thursday to the states, as some governors claimed federal money to run a new insurance pool for people with serious medical problems, while officials in other states said they would not operate the program." Democrats in Montana, Pennsylvania, and Washington "said they intended to operate the program under contract with the federal government" while Republicans in Georgia, Indiana, Nebraska and other states are declining to participate. California's Republican governor, Arnold Schwarzenegger, did embrace the program, however (Pear, 4/29).

MedPage Today: "The law provides $5 billion to fund the program from July 1, 2010 through Jan. 1, 2014. Money will be allocated based on each state's population as well as its costs. Many states already have such high-risk pools, although in some states, the pools might be more expensive for patients than the HHS-directed pools would be" (Walker, 4/29).

On Friday, a number of state officials announced their plans to take or leave the federal high-risk pool offer.

Detroit Free Press: "Michigan will create a high-risk pool later this year to provide insurance for uninsured people with chronic health problems, most likely by subcontracting the job to one of the state's health insurers, state officials said today" (Anstett, 4/30).

Charleston Regional Business Journal: "States have until today to decide whether they will create their own high-risk insurance pool or let the federal government handle it, and Gov. Mark Sanford announced today that South Carolina will not set up this additional pool" (Hadaway, 4/30).

Associated Press/CNBC: "South Carolina will not operate a new, high-risk health insurance pool for people unable to get private coverage, Gov. Mark Sanford said Friday, leaving the administration of such a program up to the federal government." Sanford said: " "There's going to be somebody holding the bag for either one or two years worth of this program. I don't think, as a fiduciary to South Carolina taxpayers, you want to put South Carolina in the role of the guy or the gal that picks up the bag" (4/30).

Associated Press/WKBT: "Gov. Tim Pawlenty says Minnesota is opting out of a new national high-risk pool for hard-to-insure Minnesotans. Pawlenty says Minnesota already has such a pool. And he's concerned that the initial $5 billion in federal funding for the program will go quickly, meaning big premium increases" (4/30).

Meanwhile, other states had already made their intentions clear.  

The Seattle Times: "Washington state will administer an interim federal insurance plan for people with serious health problems, despite already having a similar statewide high-risk pool plan in place." Washington and other states "have struggled with the complexities of having to administer two plans that appear to target the same people, but have different qualifications, premium structures and possibly benefits" (Ostrom, 4/29).

Southern California Public Radio: "The federal government offered states a choice: let Uncle Sam run a temporary insurance program for people with serious medical problems who can't get insurance - or let us pay you to do it. Governor Schwarzenegger chose the money: $761 million a year until the program dissolves four years from now.  The state will run the federal program alongside a high-risk insurance program the state already operates for about 7,000 Californians, only the feds program will cover a lot more people - as many as 25,000 Californians" (Small, 4/29).

The Atlanta Journal-Constitution: "Georgia is approaching the new health care reform law gingerly -- with skepticism and even downright opposition. ... [Georgia Insurance Commissioner John] Oxendine said he does not believe that the $5 billion in federal money set aside to help people pay their premiums will last long and he worries that the state will get stuck footing the bill." Local observers and officials say other provisions of the law could meet similar resistance (Schneider, 4/29).

Bloomberg BusinessWeek: "Nevada will opt out of operating a high-risk pool for uninsurable residents and instead delegate that task to the federal government, Gov. Jim Gibbons said Wednesday" (Chereb, 4/29).

The Salt Lake Tribune: "Gov. Gary Herbert sent a letter Wednesday to Health Secretary Kathleen Sebelius questioning the financial feasibility of the $5 billion program, which is supposed to kick in at the start of July." He wrote, "I have strong concerns that the program is severely underfunded and will ultimately result in yet another unfunded mandate on our state" (Canham, 4/29).

Omaha World-Herald: "Gov. Dave Heineman is deferring to the federal government to run a new high-risk health insurance pool for people with pre-existing medical conditions. The governor sent a letter to the federal government Tuesday saying the state cannot afford to operate the new pool" (Stoddard and Hammel, 4/27).