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18 states refuse to run insurance pools for those with preexisting conditions
Eighteen states have said they will not administer a stopgap program to provide insurance coverage to people whose preexisting conditions have left them uninsured, forcing the federal government to do the work.

The states' decisions increase the challenge the government faces as it sets out to translate the far-reaching health-care legislation into action, and they hint at the complexities to come.

At issue is a provision to extend temporary relief to people with preexisting medical conditions beginning this year, instead of making them wait until 2014, when insurers will be prohibited from turning people away or charging higher premiums based on health status. The health-care law sets aside $5 billion for the "high-risk pools."

Health and Human Services Secretary Kathleen Sebelius told state officials last month that she wanted to build on state programs, and she asked state governments to let her know by April 30 whether they would run the pools at the state level.

As of Monday, 29 states plus the District of Columbia had said they would do so, and 18 said they would leave the job to HHS. Others were undecided.

Some governors said they were unwilling to take on the task because it appears that Congress has allocated too little money. ...

...In a letter Friday to Sebelius, Virginia Gov. Robert F. McDonnell (R) said the state, which will not establish its own high-risk pool, estimates that the $113 million in federal funds available to it will be used up within 22 months. Virginia's secretary of health and human resources, William A. Hazel Jr., said Monday that setting up the pools "is an enormously complicated undertaking." ...