The Federal high-risk pool will be an insurance program administered by the Federal government. The program will set premiums, determine eligibility, and administer payments for services. Like any other insurance program.

The only difference is that

-- It is scheduled to expire at the beginning of 2014, when private insurers will no longer be able to reject people with pre-existing conditions.

-- Only a certain subset of people (those with pre-existing conditions without coverage), will be eligible.

So let's think about this. In a few months the Federal government will have set up all the necessary infrastructure to run a nationwide health insurance program. Thanks largely to Republican Governors, the program will be up and running in at least 18 states, including two of the most populous states in the nation: Texas and Florida. It will serve at least hundreds of thousands, and potentially millions, of people.

It will be, for all practical purposes, a public option -- except for the fact that the general public can't use it...

(In fact, the Public Option, as specified by the House bill that defined it, restricted access to those not covered by employer health care plans, so it would have been available to a limited set of people as well).

Now let's imagine that it is 2013. Insurance premiums have risen relentlessly despite the best, but impotent, efforts of the Government to control them (you didn't think those notices for 30% premium increases were going to stop, did you?). The demand for the government to 'do something!' about skyrocketing costs has grown ever louder. The Public Option, already known to be a big-time Government debt reducer, is back in play.

If you were a rational member of Congress (okay, okay, spare me the obvious), might you not say to yourself "Rational member of Congress, we already have the infrastructure for a national health insurance system -- the high-risk pool being run so ably by Secretary Sebelius. Why not use that mechanism to provide a public option to anyone who wants it? And do it within a few months of passage of my law making it so, instead of setting up yet another completely independent and separate program which could take years?"

Why not indeed?

(Of course, a rational person, as opposed to a member of Congress, might argue that we already have all the infrastructure needed via Medicare; that simply allowing people to buy in at cost to Medicare would make even more sense. Unfortunately, we can only assume a small subset of Congress is that rational, because there are only 19 co-sponsors of Alan Grayson's bill which does just that).

You can find more information on the high-risk pool here, on the Health and Human Services Department website: High Risk Pool Fact Sheet.

Here are the states known to be opting for a Federal program:

Alabama Delaware Florida Georgia Hawaii Idaho Indiana Louisiana Minnesota Mississippi Nebraska Nevada South Carolina Tennessee Texas Wyoming Virginia

What is the main objection these states have to administering their own risk pools? Being associated in any way with 'Obamacare' is probably the real reason, but the stated explanations are that the states could end up shouldering the cost of the program, despite HHS assurances to the contrary. Contrast HHS's statement and the statements of various Governors:

Statement by Jenny Backus, Assistant Secretary of HHS:

Whether states create these pools or the federal government creates them for states, the pools will be paid for by 100 percent federal dollars and most importantly --- uninsured people around the country will soon have access to another affordable coverage option.

Statements by various State Officers rejecting state-run plans:

...unfortunately Florida is not in a position to authorize new financial obligations. Governor Crist of Florida

But you don't have to...

"Nebraska cannot afford to subsidize a second high-risk insurance program."

Governor Heineman of Nebraska

Aside from the fact that no one is asking you to, I'm with ya...

Riley said the federal allocation for Alabama and the premiums collected would not be sufficient to cover the costs incurred by a state-run program.

Governor Bob Riley of Alabama

Except that by the statutory language of the health care law, the premiums (along with the subsidies) have to be enough...

"As we've seen in federal education and stimulus programs, the administration is again asking the states to commit to a program without knowing the rules of engagement..." Governor Perry of Texas

Rules of engagement: Say stupid, untrue things, then repeat.

...John Oxendine, a Republican candidate for governor, wrote to Sebelius that he could not let Georgia join a program "which I believe the Supreme Court will hold to be unconstitutional."

Insurance Commissioner Oxendine of Georgia

Only in John Oxendine's mind is the high-risk pool going to declared unconstitutional...

... Daniels (R) said he couldn't allow "exposing Indiana taxpayers to an open-ended and potentially enormous new burden."

Governor Daniels of Indiana

I find it highly amusing that the paranoid fears of Republican governors are going to soon lead to nationwide health insurance infrastructure and a large, Federal health insurance program being created, a for-all-practical-purposes public option that dares not call itself such.

To be fair, there is a serious concern that the $5 billion allocated by Congress to see the high-risk program through until 2014 will not sufficient. If the monies allocated are not sufficient, then something must give, by law:

-- The Secretary of HHS has the authority to raise premiums, and/or

-- The Secretary of HHS has the authority to restrict entry

to ensure the fiscal integrity of the program.

There is, of course, another option: Congress could allocate more money for the program. If more people are using it than were anticipated, this would make perfect sense, no?

Would Congress, which routinely allocates tens of billions of dollars in emergency funding for unemployment benefits during a recession, really allow cancer and AIDS patients to die because they are being denied access to health insurance insofar as the high-risk pool is in danger of being insolvent?

Come to think of it, Speaker John Boehner and Senate Majority Leader Mitch McConnell just might.