By Lisa Zamosky
I recently received a letter from a reader of this blog who is among the 25% of Americans with a health condition. She worries about what her fate will be if she one day loses her work-based insurance benefits.
I am 47 years old. Three years ago, I presented with metastatic breast cancer. Thankfully, my disease has been pretty much stable, but I have a monthly standing appointment at my cancer center. Every three months I go for scans.
I am fortunate that I am employed and have health insurance. But I work in a somewhat precarious field–lots of layoffs and little growth. If I were to lose my job, after COBRA expires, I believe I would have to apply to the state [high risk] pool–would that still hold true in 2014?
High-Risk Pool Insurance Programs
High risk pools are insurance programs made available to people with medical conditions who are considered uninsurable. People with cancer, heart disease and other serious ailments often use these pools as health insurance of last resort.
The Affordable Care Act set up a national interim high-risk pool program, which started in 2010, and is available to people with pre-existing health conditions who have been uninsured for at least six months.
In addition, prior to the law taking effect, 35 states already had high-risk health insurance pools established. These have been in existence for over 25 years, with many first opening in the mid-1970s. 
Guaranteed Coverage by Law
Perhaps the most prominent aspect of the Affordable Care Act is that starting January 1, 2014, insurers are prohibited from denying anyone coverage, regardless of their medical condition.
That means that if you lose your job, get divorced, or for any other reason find yourself without health insurance, you will be able to shop for coverage on one of the state-based online markets and be guaranteed a health plan beginning next year.
Both the federal Pre-Existing Condition Health Insurance program (PCIP) established by the health reform law, and the older state-based high-risk insurance pools will eventually be disbanded. With guaranteed coverage for everyone, they will no longer be necessary. To ensure a smooth transition into the new insurance markets, however, these programs in many states are likely to remain open for some time beyond 2014.
For this reader and others who struggle with on-going medical conditions and don’t have access to work-based health insurance, the guarantee of coverage regardless of one’s health could literally mean the difference between life and death.
Your turn: What are your biggest concerns about health insurance and how you might be affected by the health reform law? Please share your comments and questions in the section below.
1. National Conference of State Legislatures. High Risk Pools: http://www.ncsl.org/issues-research/health/high-risk-pools-for-health-coverage.aspx