Georgia's High Risk Health Insurance Pool

For starters, Georgia does not have a high risk health insurance pool. Not yet any way. But part of Obamacare includes a provision to establish or expand high risk pools at the state level.

Many states already have established risk pools, but some, like Florida and Maine have been closed to new entrants for some time due to lack of funding. Just this week, HHS Sebelius sent letters out to all 57 states informing them of risk pool funds and asking for feedback on their desire to participate.

I didn’t realize this was an option.

The feds are using $5 billion of our money they don’t have to seed this new program. I am sure the Chinese are happy we are putting their money to good use.

Individuals who are interested in participating in this newly created pool must meet the following requirements.

Be a citizen or national of the United States or lawfully present in the United States;

Not have been covered under creditable coverage (as defined in Section 2701(c)(1) of the Public Health Service Act) for the previous 6 months before applying for coverage; and

Have a pre-existing condition, as determined in a manner consistent with guidance issued by the Secretary.

Now that’s interesting.

You must have a pre-existing condition that is consistent with the guidelines as determined by the HHS. Wonder what those guidelines are and if they will have to be amended once someone with an illness or condition not on the list complains?

Premiums Must:

Be established at a standard rate for a standard population (that is, not exceed 100 percent of the standard non-group rate); and

Not have age rating greater than 4 to 1.

This conflicts with information provided an an internal memo sent to at least one state Department of Insurance a few weeks ago. That aside, charging a rate that is “not greater than 100% of a standard non-group rate” is insufficient to cover the risk associated with those previously deemed “uninsurable”.

In other words, this won’t fly.

So expect to dig deeper to pay the taxman enough to float this baby.

The 100% of standard premium cap is less than the guideline used in any state that currently has a risk pool. Caps currently run from 125% to 200% with most states in the 150 – 200% range.

HHS Sebelius was former insurance commissioner of Kansas, then governor, before taking a position in the Obama cabinet. One would think that she would know the 150% rate cap for the Kansas risk pool was not adequate and would not promote a program that is doomed to fail.

Apparently that is not the case.

No word yet on what Georgia will do, but my guess is they will let the feds run it. Why gear up for a plan that will be abandoned by 2014?

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