Health Reform Step-by-Step: The Temporary High-Risk Pool (UPDATED!)

The Patient Protection and Affordable Care Act is a long, complicated document that will cause real changes in the way that you and your family access and pay for health insurance. Texas Impact is committed to helping you understand the bill and making sure that you get the benefits available to you. In the coming weeks, we will pick apart the bill—starting with the provisions that go into effect in 2010—so you can see who will be affected.

The Temporary High-Risk Pool

One goal of healthcare reform is to expand access to affordable insurance to those who cannot afford it. To that end, the Patient Protection and Affordable Care Act establishes broad coverage provisions that take effect in January 2014. Until then, however, the Act sets up a temporary high-risk pool for people who have pre-existing medical conditions and are without insurance.

Beginning on June 21, 2010, all individuals who have a pre-existing condition and how have not had health insurance for six months are eligible to enroll in the Temporary High-Risk Pool. This pool is meant to serve as a final safety net for those without insurance. To discourage people from switching from private insurance into this plan, the Act mandates that individuals must be without insurance for six months before enrolling.

The Temporary High-Risk Pool provides benefits that many plans, including Texas' own high-risk pool, do not offer. Kathleen Sebelius, Secretary of Health and Human Services, will determine the minimum benefits in the package, but right now we know that this plan must cover at least 65% of healthcare costs, that out-of-pocket spending is limited to $5,950 for individuals and $11,900 for families, and that premiums must be set as if for a 'standard' population, rather than a 'high-risk' population. Hopefully, the provisions will help keep this plan affordable for Texans. The federal pool, though, does allow for premium variation by age, geographic area, family composition and tobacco use.

States had various options as to how they would choose to administer this program. HHS Commissioner Tom Suehs told Secretary Sebelius on April 30, 2010 that he would allow the federal government to operate the pool in Texas. More information about how the federal government will operate the program will be forthcoming.

Updates on the Temporary High Risk Pool (PCIP)

To see the Kaiser Foundation's analysis of this provision, click here.

To see Secretary Sebelius' letter to states about developing a high-risk pool, click here.

For more information about how the Affordable Care Act will affect Texas, click here.

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