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Track This Leading Indicator of Health Care Reform

In this season of tests and final examinations, the new national health care reform law faces a crucial test of its own: the July deadline for implementing a high-risk insurance pool for several million Americans who have been unable to secure health insurance because of chronic preexisting health conditions.

Rejected by private insurance companies because they have cancer, cerebral palsy, diabetes—and in some cases even hay fever—they are among the nation’s most vulnerable citizens, whose care is the most expensive.

By 2014, they are to be insured by private insurance companies. But in the meantime, the Obama administration must quickly assemble a 50-state network that provides them with affordable stopgap coverage.

It won’t be easy. There are three early indicators to watch—the states, the calendar and the $5 billion in available funding. Today, 35 states have their own high-risk pools, insuring some 200,000 otherwise uninsured people, with premiums and coverage varying widely.

The federal government hopes to contract with these states and expand their programs. But will the states cooperate? One troubling early indicator is that 18 of the 35 states with state-run insurance pools have joined a lawsuit challenging the national statute. In states without high-risk pools or that refuse to cooperate, the Department of Health and Human Services must establish separate machinery or contract with nonprofit agencies in those states.

The program is supposed to be launched by July. Can the necessary agreements, regulations and procedures be in place by then? Finally, is $5 billion sufficient? The state pools are funded by a combination of premiums, hospital fees and in some cases proceeds from the 1998 tobacco settlement. The 200,000 enrolled in existing state pools consumed $1.9 billion in 2008; but the Government Accountabilty Office forecasts that there may be as many as 4 million across Amerca—half of them 50 and over—who qualify for the pools.

Meeting the July deadline is, simply, an early and important test of how effectively the country’s new health care insurance program will be implemented. Frankly, it’s also a test of whether the government can effectively create and administer a complicated program. In 1965, when Medicare was launched, the American people, with memories of World War II and postwar successes still fresh, had confidence in their government—over 75 percent trusted government “most or all of the time,” according to national polls. Today, public confidence has fallen by more than half.

A recent forecast by HHS Secretary Kathleen Sebelius was both pragmatic and guardedly optimistic. “There will be bumps along the way. There will be twists and turns. It will not be easy,” she said. “But after decades of standing still, we are finally moving forward.”

We’ll be watching. The high-stakes test is the high-risk pool. First test results will be posted this summer.

Jim Toedtman is editor of AARP Bulletin.

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