Enrollment in high-risk insurance pools lagging behind predictions

Donald Berwick
Donald Berwick (Richard Chase - Via Bloomberg)
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Washington Post Staff Writer
Thursday, February 10, 2011; 9:35 PM

More Americans have been signing up for special health plans designed for people with medical problems that caused them to be spurned by the insurance industry, according to new government figures. But enrollment continues to lag significantly behind original predictions.

The number of people who have bought the plans, known as high-risk pools, has increased from slightly fewer than 8,000 nationwide as of early November to nearly 12,500 as of the beginning of this month, according to figures released Thursday by federal health officials.

Several months ago, the special insurance pools became one of the earliest facets of the new health-care law to take effect. They are intended as a temporary coping mechanism for people with medical conditions that traditional insurance companies do not want to cover. The program is temporary, because, starting in 2014, the law will forbid insurers to reject customers based on whether they are healthy or sick.

Last spring, the Medicaid program's chief actuary forecast that 375,000 Americans would have joined new high-risk pools by the end of 2010.

Late last year, administration officials said the plans' relative lack of popularity reflected early growing pains; they predicted that enrollment would grow swiftly as more people found out that they exist. Some state health officials and would-be customers said the more fundamental problem is that insurance for people with medical problems remains too expensive for some.

The law gave states the choice of starting an insurance plan for preexisting conditions or letting their residents enter a federal plan. Twenty-seven states have started their own. The new high-risk pool has attracted the greatest number of participants in Pennsylvania, where nearly 2,050 people have signed up, about 400 more than three months earlier.

In the Washington area, the District and Maryland have created their own pools, with 10 and 145 customers, respectively. Virginia, relying on the federal pool, has 204 participants.

Health and Human Services officials released the updated enrollment figures on the same day that the agency's top official in charge of Medicare, the public insurance programs for older Americans, made his first appearance before a House committee.

The House's new Republican majority used the session with Donald M. Berwick, administrator of HHS's Centers for Medicaid and Medicare Services, to amplify - but not add any new elements to - their criticism of the health-care law.

GOP House members reprised their long-running complaint about the effects of the law on a part of Medicare, known as Medicare Advantage, in which older Americans can be covered through private health plans. Democrats have warned for years that the government was overpaying these plans, and the law will over several years curb reimbursement rates to slow rampant growth in medical spending. On Thursday, Republicans renewed their assertions that the change in payments will make it more difficult for Medicare patients to find private health plans - a prediction that Berwick dismissed.

Berwick announced Thursday that, for 2011, the number of people who chose a Medicare Advantage plan has grown by 6 percent, slightly more than the insurance industry's prediction. Republican lawmakers countered that the growth is misleading because the changes in reimbursement rates have not taken effect.

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