High-Risk Pools: An Illusion of Coverage That May Increase Costs for All in the Long Term
High-risk pools are included as a state option in the American Health Care Act (AHCA) recently passed by the U.S. House of Representatives. These plans segregate persons with preexisting conditions from the broader insurance pool to a much smaller pool with others who have potentially high costs. Historically, high-risk pools have not worked well. They generally have not provided affordable or adequate coverage to persons with preexisting conditions, nor have they made the individual market affordable for others. Moreover, they have cost more than policymakers seem to appreciate on the basis of allocations for high-risk pool programs in past and current legislation. As they consider changes to the Patient Protection and Affordable Care Act (ACA), policymakers seem to have forgotten that high-risk pools operated in 35 states before the ACA was passed. At that time, the United States had 47 million uninsured people, 33 million of whom lived in states with high-risk pools, strongly suggesting that the pools were not making insurance affordable and accessible for people with or without preexisting conditions. Indeed, the Congressional Budget Office estimates similar levels of uninsurance under the AHCA (1). For all these reasons, any legislation reinstituting high-risk pools would constitute a huge step backward for American health care policy.