Issues for Structuring Interim High-Risk Pools

One of the first provisions that would be implemented under federal health reform bills in the House and the Senate would establish a national high-risk pool program to offer coverage to otherwise uninsurable individuals during the interim period between enactment and implementation of broader health care reforms.

High-risk pools provide a safety net for people who are denied coverage by private insurers due to their health. Most states that permit insurers to decline applicants for health reasons have high-risk pools today. The House and Senate bills would extend risk pool protection nationally, reduce the costs of risk pool coverage for many participants, and provide $5 billion dollars to subsidize the costs of coverage. The House and Senate provisions are similar, but not identical, and their provisions would need to be reconciled in any final health reform legislation.

This brief examines the role of high-risk pools as a coverage safety net today and reviews key issues involved in implementing a national high-risk pool. It was authored by Karen Pollitz of the Georgetown University Health Policy Institute.

Brief (.pdf)