Policy Examples

• Prior to implementation of the ACA, 35 states offered high-risk pools as a source of non-group health insurance for eligible residents. As of mid-2016, 13 states were still operating high-risk pools. Some of them are still accepting new members, although enrollees must meet the existing eligibility guidelines. source
• The first high-risk pools were implemented by Minnesota and Connecticut in 1976; North Carolina implemented a high-risk pool in 2009. Pools offered eligibility to people in one or more of the following categories: medical, HIPAA, HCTC, and Medicare. SOURCE
• The Affordable Care Act (ACA) established a temporary federal high-risk pool to individuals with pre-existing conditions that would not be eligible for coverage until 2014. These Pre-Existing Condition Insurance Plans (PCIP) provided coverage for up to 114,000 at its peak in mid-2013 and claims averaged an unsustainable 600% of premiums in late 2013. SOURCE
• Some proposals published in 2017 would repeal or weaken rules prohibiting health insurance discrimination based on health status, instead offering high-risk pools as a source of coverage for people who would be uninsurable due to pre-existing conditions. source

Outcome Evidence

• The first high risk pools were implemented by Minnesota and Connecticut in 1976; North Carolina implemented a high-risk pool in 2009. Pools offered eligibility to people in one or more of the following categories: medical, HIPAA, HCTC, and Medicare. source
• In 2017 the Commonwealth Fund reported that high-risk pool coverage is prohibitively expensive and there is little evidence to suggest that the existence of such pools make coverage less costly for others in the individual insurance market. source