Expanding individual health insurance coverage: Are high-risk pools the answer?

Health Affairs

Volumn 22, Issue SUPPL., 2003, Pages

  Chollet, Deborah ^a  

^a MATHEMATICA POLICY RESEARCH   (United States)

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EID: 27544498450     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: None     Document Type: Review

References (6)

1. L. Achman and D. Chollet, Insuring the Uninsurable: An Overview of State High-Risk Health Insurance Pools (New York: Commonwealth Fund, August 2001).
2. States that use the high-risk pool to comply with HIPAA's portability rules may not close the pool to HIPAA-eligible individuals (that is, individuals who are leaving group coverage, have had at least eighteen months of continuous coverage, and apply for coverage in the high-risk pool within sixty-three days).
3. Minnesota's enrollment - 6 percent - also offers a reasonable measure of the proportion of the nonelderly population that is uninsurable in a comprehensive managed care environment (in contrast to the 1 percent rule of thumb commonly used), although the number might be lower in states where greater prevalence of indemnity coverage offers insurers more opportunity to scale back benefit design or greatly raise cost sharing.
4. Assume that the individual's expected health care costs equal a certain expenditure (A) plus an uncertain and independent expenditure [E(B)], that E(B) = 0.5A, and that the price of insurance (P) is actuarially fair. Thus P = E(A) + E(B) = A + E(B). Solving for A, A = 0.67P. The individual's first-year expenditure would equal the full premium (P) plus the uninsured certain medical expenditure (A): P + A = 1.67P.
5. In 1997, group insurance premiums accounted for 95 percent of total premium volume nationwide. See D. Chollet, A. Kirk, and M. Chow, Mapping State Health Insurance Markets: Structure and Change in the States' Group and Individual Health Insurance Markets, 1995-1997 (Washington: Academy for Health Services Research and Health Policy, December 2000).
6. P. Butler, "ERISA Complicates State Efforts to Improve Access to Individual Insurance for the Medically High Risk," Robert Wood Johnson Foundation State Coverage Initiatives Program, Issue Brief 1, no. 3 (Washington: AHSRHP, August 2000).