States mull extending high-risk pools amid exchange problems

High-risk pools, once predicted to be extinct in the post-reform insurance market, might live to see some more days after all of the technical problems with the federal health insurance exchange.

Several states are considering extending the pools, which could benefit insurers because it would delay the movement of consumers with expensive medical conditions and chronic illnesses into their membership rolls. But it also could boost uncertainty and increase rates for all consumers next year, reported the Wall Street Journal.

About half of the 35 states that operate the pools, which insure about 200,000 consumers, had planned to close them by the end of the year since the reform law requires insurers accept all consumers regardless of health history.

For example, Wisconsin, whose high-risk pool has about 22,000 members, is holding a special legislative session with a goal of extending the program by three months. Texas also is considering whether to extend its high-risk pool for about 23,000 members. And in Indiana, the high-risk program will remain open at least one additional month and might be extended if HealthCare.gov doesn't improve.

The problem, however, for insurers is they must set rates for 2015 by next spring. If they only have a few months of claims data, they may take a cautious approach by pricing premiums higher for all individual policies to offset any additional costs they may incur with the extension of the high-risk pools, whose members average about $11,000 in medical claims a year.

Extending these high-risk programs could have a similar effect as postponing the enrollment deadline, which America's Health Insurance Plans says could destabilize insurance markets because open enrollment would continue beyond when insurers set rates for 2015. So they would be basing premium costs on the sicker, more expensive members, FierceHealthPayer previously reported.

To learn more:
- read the Wall Street Journal article

 

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