High Risk Pool – Why Health Insurers Must Pay Their Fair Share

By: - June 26, 2007 4:31 pm

A health insurance high risk pool is a state-administered health plan where people with serious illnesses can buy health coverage at high but not unaffordable rates.   For more details read the op-ed I wrote back in March about the pool, “Why we need a health insurance high risk pool.” 

The debate in the Senate Commerce Committee today regarding the bill that passed the House establishing such a pool set a new low.  A parade of industry lobbyists – in drearily predictable fashion – came before the committee pretending support while doing their best to wriggle out of paying their fair share of the costs of coverage.

Every health industry lobbyist and business interest speaking started out by saying how much they supported the idea of the risk pool.  But….ah yes, the classic lobbyist “but.”  But, they thought the funding should come all from tax dollars and not an assessment on health insurers. 

Sorry.  In the high risk pool, 60% of the cost is paid by people who join the pool and pay premiums.  The other 40% is shared between the state – which does contribute based on the number of people in the state health plan, an assessment on private insurers, and finally doctors and hospitals contribute by agreeing to accept lower rates of payment.

In addition to fairness, there are multiple good reasons why insurers should be assessed to help cover the pool costs.  Four clear ones are detailed in the latest NC Health Report.  The main one is this – there needs to be a stable funding source for the pool that increases with population.  A health plan like this can be subject to closure every year if the General Assembly finds itself in a budget shortfall.  That’s just not fair to someone paying a $800 a month premium.

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