TED NICKEL: I Ran Wisconsin’s Successful High-Risk Pool Before Obamacare. It Actually Worked.

Prior to the ACA, Wisconsin consumers could choose from over 20 individual insurance companies offering coverage in our state. These included for-profit and not-for-profit companies; HMO’s and PPOs; and local and national insurers. There were a variety of plan options to meet a range of coverage needs.

While these plans were underwritten, individuals denied coverage would receive coverage from Wisconsin’s high-risk pool known as the Health Insurance Risk Sharing Plan (HIRSP). HIRSP provided Wisconsin consumers with peace of mind by providing high quality, comprehensive coverage to over 20,000 of our friends and neighbors.

Unlike the current ACA market where most people must wait until open enrollment to purchase coverage, consumers could enroll in HIRSP at any time. There were no pre-existing condition limits for people signing up for coverage if they had prior coverage. If consumers had no prior coverage, they would receive coverage for most conditions, but had to wait six months for pre-existing conditions.

In contrast, with Obamacare you may have to wait up to 11 months for any coverage if you miss open enrollment.

Once enrolled in HIRSP, consumers chose from a variety of benefit plans including both high and low deductible plans. While Obamacare plans are criticized for having narrow networks, there were no network limitations for HIRSP; members were able to visit any medical provider in our state and receive coverage when traveling outside of Wisconsin. Subsidies were also available to offset premiums, deductibles and prescription drug out-of-pocket maximums for low-income members.

HIRSP benefit and administrative costs were funded by member premiums and contributions from insurers and providers. No state dollars were needed to support this program.

Though not perfect (no program is), HIRSP was well-run and kept the needs of its members a priority and was structured in a way which allowed sufficient flexibility to address member needs and respond to evolving market dynamics. Former members of HIRSP continue to call legislative offices requesting a reinstatement of this program.

“Before Obamacare” being the key phrase.