But the cost increases are similar to those experienced by all other health plans - company plans, group plans, Medicare, Medicaid. Cost problems are more of an issue for states, like California, Illinois and Louisiana, that have a set state appropriation. The costs of operating risk pools are still very small, especially when compared to overall size of insurance markets. Minnesota's risk pool, for a two year period, received a portion of the state's provider tax fund, which is used to fund a large low income health insurance subsidy program. This was challenged in court, and was upheld by the courts.
Legislative language is key.
Oregon pioneered assessing stop-loss carriers. Oregon assesses on a per person basis, rather than on a percentage of premium dollars. Can assess stop loss carriers on an equitable basis allowing easier pass-on. State must have enforceable regulations that require stop-loss, reinsurance carriers providing covering health plans to report to the state, including number of lives covered. For fairness, it is best to have language that exempts stop-loss, reinsurers from having to pay assessment on any plans that can show they have already paid into the pool.