Currently, it is possible for someone to contract a long illness, lose their job, exhaust COBRA and be unable to find insurance. This is the uniquely American nightmare that reform is designed to eliminate. Temporary high-risk pools are included in the legislation as a stop-gap measure for people who can’t get coverage until reform is fully implemented in 2014. These plans must be in operation within 90 days of enactment.

Implementation of this program is greatly simplified by the fact that about 32 states now have high-risk pools, although many applicants are turned away due to a lack of funding. Where available, the state high-risk pool typically covers people in the individual market with pre-existing conditions who have been declined for coverage by an insurer. Typically, insurers in these states will refer applicants to the high-risk pool if they have one or more of 30 to 50 specified health conditions. About 200,000 people nationwide are covered in these pools.

Participants pay a premium equal to between 150 percent and 200 percent of “standard risk,” where standard risk is defined to be average expected costs for the general population of the same age. In most pools, the premium varies with every single year of age, which for people age 55 and older, results in premiums that increase sharply as people age from one year to the next.

Even at these premiums, expenses in the pool generally exceed premium revenues. Most states pay for losses with an assessment on insurance in the fully insured markets. Others pay for losses with tobacco taxes or other revenues. Congress has provided $5.0 billion in funding for the new high-risk pools until 2014.

Under the act, people are eligible for the new pools if they have a preexisting condition, are a citizen or lawful immigrant, and have been uninsured for at least six months. The six- month waiting period differs from most state pools where someone who has exhausted COBRA and other options can enroll immediately after that coverage expires so they have continuous coverage (assuming adequate state funds are available). These temporary high-risk pools will do little for this group.

The states that now have high risk pools should be able to adapt to the legislation relatively quickly. It appears that the new program would be operated as a companion to existing state high-risk pools. However, premiums under the new program would be equal to only 100 percent of standard risk, compared with at least 150 percent of standard risk in existing pools. The act also limits premium variation by age to a maximum of 4 to 1 (from highest to lowest), which greatly reduces premiums for people age 60 and older in particular.

A strange feature of these high risk pools is that people would not be able to enroll in these pools until they have been uninsured for at least six months. This will be of little use to people with illnesses who are trying to preserve their coverage once their COBRA or other insurance options terminate. These people would still need to depend upon existing high-risk pools with high premiums and huge deductibles.

For many of our nation’s most vulnerable citizens, early insurance reforms will be extremely helpful. This cannot be overstated.

It is unfortunate that some, such as contributor John Goodman, seek to dismiss the importance of eliminating lifetime caps and pre-existing condition exclusions as impacting “only a small fraction of people.” In fact, these early reforms are nothing less than a lifeline for those with cancer, asthma, diabetes, spina bifida, bleeding disorders such as hemophilia, and a range of other conditions that lead insurance companies to deny or limit coverage every day. As George Washington University Professor Sara Rosenbaum has pointed out, “a child who develops autism, or cancer, or sickle cell disease, or cystic fibrosis should not face discrimination either at the point of enrollment or following enrollment.” For children, this is nothing less than a life or death issue. A child living with a congenital heart condition can reach the “lifetime cap” at a very young age, despite the need for further heart surgeries as he or she develops over time.

The range, reach, and impact of these crucial insurance reforms go well beyond those immediately affected. Each of us know someone who relied on health insurance to cover a critical procedure or health care need only to find their coverage denied at such a vulnerable moment. These situations are the reason most people buy health insurance, and the health reform law’s early reforms will help ensure every person with insurance has the guarantee of full coverage, especially when it is urgently needed.

Just in the past few weeks, national media attention focused on the story of Houston Tracy, a newborn who needed life-saving surgery to repair a heart defect. Houston was denied health insurance coverage from Blue Cross Blue Shield of Texas because his defect was declared a “pre-existing condition.” Public outrage forced Blue Cross Blue Shield to find a solution and provide such coverage for the child’s care and treatment. For Houston Tracy, his family, and the hundreds and thousands of American children in similar situations, halting coverage denials based on pre-existing conditions is something that the legislation addressed. It should not be undermined and cannot be understated.

Mr. Goodman also declares the “polls are clear,” despite evidence that actually shows public opinion is still very much undecided on the overall health reform package. However, it is actually on the matter of these early insurance reforms that the nation’s viewpoint is quite apparent. With respect to provisions related to prohibiting insurance companies from denying coverage based on pre-existing conditions and allowing young adults up to age 26 to continue to receive insurance coverage on their parents’ plan, the public overwhelming supports both provisions by 73-26% and 82-16% margins, respectively.

In the end, if you’re still questioning whether early reforms are helpful or just trivial, just ask the Tracy family.

The polls are clear. People do not believe that ObamaCare will solve the problems of rising costs and inadequate quality. In fact, they believe it will make those problems worse.

So President Obama is talking about “insurance reform” issues, because this is the only area where he has any credibility left. As I said in my editorial at National Review, he is playing “trivial pursuit,” because those are the only cards he has left to play.

Consider these fairly routine stump speech phrases:

• “Insurers will not be able to drop your coverage after you get sick.” True enough. But this practice has been illegal for the last decade-and-a-half under HIPAA.

• “There will be no more lifetime caps on health insurance benefits.” Good news, no doubt, for the 1/100th of 1% of the population who bumps up against them.

• “If you have a 26-year-old dependent child who can’t get health insurance elsewhere, you will be able to cover him on your own health plan.” Well, okay. But how many 26-year-olds have this problem? I gather not many.

• “If you have a child or adopt a child, your insurer will not be able to exclude him because of a pre-existing condition.” Don’t most states already require this? And isn’t it standard insurance practice anyway?

• “In four years, no insurer will be able to discriminate against anyone because of a pre-existing condition.” True enough. But more than 90% of everyone in the United States with health insurance is already in a plan that can’t exclude people because of pre-existing conditions. And for the other 10%, only a small fraction faces serious problems.

For the people who have the problems just described, the problems are real and sometimes tragic. But they represent a minute fraction of the overall set of problems ObamaCare is designed to address.

Over the course of the next few months, the new health care law will be a matter of life and death to some and peace of mind to many. A high risk pool for people with a major disease or any type of pre-existing condition can ensure they have access to life-saving treatments. Parents with a child graduating from college will rest easy because they can put their son or daughter on their policy during that first job search or if that first job that doesn’t provide health care. Whether these early changes are beneficial to Americans or are used as opportunities to continue the fight over reform itself depends on the choices of the principle actors: federal and state leaders and insurers.

State leaders face a choice about providing a high-risk pool to people who have a pre-existing condition and lack coverage. They can choose to work with HHS Secretary Kathleen Sibelius who has asked for their cooperation or they can fight the new law at all costs. The smart choice would be to look beyond the immediate legal and political fights over the new law and do right by their residents who are desperate for help. Such cooperation would mean that people with pre-existing conditions will know where to go to get coverage and receive prompt attention to their needs.

Insurers will face a choice about premium increases. They can either work to fix potential problems with the new law that could drive up premiums or blame the increase on the new law. For example, the new requirement that children up to age 26 have the option to be included on their parents’ health plan could drive up premiums. It depends on whether the new young adults are less healthy on average than current dependents. It has not been a problem in the 30 states that already extended such coverage to young adults, but the smart choice for insurers would be to anticipate any problems and propose solutions before the problems occur.

Federal regulators will face a choice, too. They will have to make tough decisions about regulating insurance companies that Congress couldn’t make. For example, the law sets new limits on insurance companies’ administrative costs, but gives the Secretary of HHS the flexibility and responsibility to make sure that such limits don’t destabilize insurance for individuals. The problem is that insurers have multi-year contracts with insurance agents and will require time to lower those costs to meet the new limits on administrative costs. The smart choice for HHS would be to work with insurers so they don’t have to drop policies because the new limits don’t allow for an appropriate transition period.

These kinds of problems, which arise during the implementation of any law, would not ordinarily be that tough. The hard part will be putting aside the political rhetoric and dealing with each other in good faith for the benefit of all Americans.