High-Risk Pools: An Illusion of Coverage That May Increase Costs for All in the Long Term
Authors: Jean P. Hall
Journal: Annals of Internal Medicine (2017)

Ideas and Opinions1 August 2017High-Risk Pools: An Illusion of Coverage That May Increase Costs for All in the Long TermJean P. Hall, PhDJean P. Hall, PhDFrom University of Kansas Medical Center, Kansas City, Kansas.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-1196 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail 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 ...References1. Congressional Budget Office (CBO). American Health Care Act–Budget Reconciliation Recommendations of the House Committees on Ways and Means and Energy and Commerce. Washington, DC: CBO; 13 March 2017. Accessed at www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/americanhealthcareact.pdf on 10 May 2017. Google Scholar2. Chait J. Republican blurts out that sick people don't deserve affordable care. New York Magazine. 1 May 2017. Accessed at http://nymag.com/daily/intelligencer/2017/05/republican-sick-people-dont-deserve-affordable-care.html on 10 May 2017. Google Scholar3. U.S. Department of Health and Human Services. Health insurance coverage for Americans with pre-existing conditions: the impact of the Affordable Care Act. Washington, DC: U.S. Department of Health and Human Services. ASPE issue brief; 5 January 2017. 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Google Scholar7. Sloan C. Proposed high risk pool funding likely insufficient to cover insurance needs for individuals with pre-existing conditions. Washington, DC: Avalere; May 2017. Accessed at http://avalere.com/expertise/managed-care/insights/proposed-high-risk-pool-funding-likely-insufficient-to-cover-insurance-need on 10 May 2017. Google Scholar8. National Association of State Comprehensive Health Insurance Plans (NASCHIP). Comprehensive Health Insurance for High-Risk Individuals: A State-by-State Analysis. Denver: NASCHIP; 2009. Google Scholar9. Hall JP, Moore JM. Does high risk pool coverage meet the needs of a population at risk for disability? Inquiry. 2008;45:340-52. CrossrefMedlineGoogle Scholar10. American Academy of Actuaries (AAA). Steps toward a more sustainable individual health insurance market. AAA issue brief. Washington, DC: AAA; April 2017. Accessed at www.actuary.org/content/steps-toward-more-sustainable-individual-health-insurance-market on 10 May 2017. Google Scholar Author, Article, and Disclosure InformationAffiliations: From University of Kansas Medical Center, Kansas City, Kansas.Financial Support: Funding for this study was provided by The Commonwealth Fund.Disclosures: Author has disclosed no conflicts of interest. Form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-1196.Corresponding Author: Jean P. Hall, PhD, University of Kansas Medical Center, Department of Health Policy and Management, Mail Stop 3044, 3901 Rainbow Boulevard, Kansas City, KS 66160; e-mail, [email protected]edu.Author Contributions: Conception and design: J.P. Hall.Analysis and interpretation of the data: J.P. Hall.Drafting of the article: J.P. Hall.Final approval of the article: J.P. Hall.Obtaining of funding: J.P. Hall.This article was published at Annals.org on 23 May 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byThe Interrelationship of Health Insurance and Employment for People with Disabilities 1 August 2017Volume 167, Issue 3Page: 200-201KeywordsHealth careHealth care policyHealth insuranceLegislationParalysisPatient Protection and Affordable Care ActPrimary hypertensionPsychiatry and mental healthSubstance abuseSurgery ePublished: 23 May 2017 Issue Published: 1 August 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...