High-risk pools may represent step back for U.S. health care

(HealthDay)—Proposed legislation as part of the American Health Care Act, which includes the option of high-risk pools, is not likely to reduce costs, according to an Ideas and Opinions piece published online May 23 in the Annals of Internal Medicine.

Jean P. Hall, Ph.D., from the University of Kansas Medical Center in Kansas City, discusses high-risk pools, which segregate persons with preexisting conditions from the broader insurance pool to a smaller pool with others who have potentially high costs.

Hall notes that high-risk pools operated in 35 states prior to implementation of the Affordable Care Act, during which time there were 47 million uninsured people, including 33 million who lived in states with high-risk pools, suggesting that these pools were not making insurance affordable or accessible. Historically, high-risk pool coverage was associated with high premiums and deductibles and serious limits on coverage. High-risk pools developed under the proposed legislation are likely to have stringent coverage limits. Higher premiums, deductibles, and out-of-pocket costs allowed under the proposed legislation may make high-risk pool coverage unaffordable for many people.

"Insurance works best when it spreads costs across a large pool of people, limiting the effects of those with higher costs on overall rates," Hall writes. "High-risk pools do not work, because they concentrate costs and require subsidies at a level that policymakers have never funded adequately."

Support for this article was provided by The Commonwealth Fund.

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