High Risk Pools Are a Costly, Ineffective Way to Deliver Care to People with Pre-Existing Conditions

Affordable Care Act’s guaranteed coverage, income-based tax credits and coverage mandate are the best way to guarantee coverage to people with pre-existing conditions

Boston, MA and Washington, D.C. – High-Risk Pools, a cornerstone of Republican proposals to repeal the Affordable Care Act, are costly and ineffective and would impose large premiums on people with pre-existing health conditions, according to health experts, faith and patient groups, and a former high-risk pool enrollee who all participated in a media teleconference today. Audio of the call can be accessed here.

Yesterday, the CBO reported that the American Health Care Act, the House Republican plan to repeal the Affordable Care Act, would cause 24 million Americans to lose their health insurance by 2026. The House GOP plan doesn’t include a high-risk pool. However, it sets aside funds for states to establish high-risk pools or reinsurance, but doesn’t provide adequate funding to meet the needs of either program along with its many other purposes (which include cost sharing subsidies and prevention). Speakers on today’s call cautioned that it would be a major step backwards to rely on high-risk pools to cover people with pre-existing health conditions.

“Going back to the days of high risk pools would be terrible for consumers, and we certainly hope no future bills moving through Congress will do that: people could not easily find a pool that would serve them, and high risk pool plans came with high premiums, waiting periods, and benefit caps,” said Cheryl Fish-Parcham, director of Access Initiatives at Families USA.

“The Affordable Care Act took a private insurance system that routinely denied sick people coverage – forcing states to rely on costly and ineffective high-risk pools – and transformed it into a market that provides affordable coverage options to everyone, no matter the status of their health,” said Ashley Blackburn, senior policy analyst, at Community Catalyst.   

Former high-risk pool enrollee and cancer survivor Michael Kappel said he had to jump through a number of hoops to get care through a pre-ACA high-risk pool in his home state of Georgia and the plan included a worrisome lifetime coverage cap. He found much better health security and peace of mind through his Affordable Care Act plan.

“For a cancer survivor, dealing with the collateral damage of cancer treatment and the continued surveillance for recurrence or secondary cancers, going without insurance is simply not an option. I am very worried that the proposed replacement for the ACA will harm cancer survivors, particularly people with low incomes and people over the age of 50. We simply can’t go back to the days before the ACA when cancer survivors could be denied coverage, and we have to ensure people have access to quality, affordable health insurance,” said Kappel , a board member of the National Coalition for Cancer Survivorship.

“For people of faith, the obligation is community,” said Sister Simone Campbell, SSS, executive director of NETWORK Lobby for Catholic Social Justice. “High-risk pools separate out those most in need of coverage. Our faith teaches compassion and solidarity, but quarantining those with greater medical needs is just the opposite. As a person of faith, I know that when we don’t care for those who are most marginalized, it hurts all of us. The economics of a high-risk pool have never really worked, but for me, it’s faith that reminds us that we are in this together.”

“The Republican replacement bill leaves us with more questions than answers with regard to the future of high-risk pools. It relies on one of the cornerstones of the ACA – protecting people with pre-existing conditions – which begs the question: why would a state set up a high-risk pool in the first place?” said Michael Miller, director of Strategic Policy at Community Catalyst.

Today’s call was the fourth in a seven-part series of teleconferences designed to explain in layman's terms the impact of repealing the ACA, and the various replacement proposals currently being discussed, to journalists who may be unfamiliar with these ideas and how they could affect their readership or audiences.
These calls are being sponsored by the Protect Our Care Coalition. Different organizations within the coalition will be hosting and participating in these teleconferences.

Future calls will be held at 11:30 AM (EST) on the following days:

  • Thursday, March 16: The Problems with Continuous Coverage Provisions
  • Tuesday, March 21: Essential Health Benefits/Preventive Services
  • Thursday, March 23: Selling Across State lines

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Community Catalyst is a national, non-profit consumer advocacy organization founded in 1998 with the belief that affordable quality health care should be accessible to everyone. For more information, visit www.communitycatalyst.org. Read our blog at http://blog.communitycatalyst.org. Follow us on Twitter @healthpolicyhub.

Families USA, a leading national voice for health care consumers, is dedicated to the achievement of high-quality, affordable health care and improved health for all.

Founded by and for cancer survivors in 1986, the National Coalition for Cancer Survivorship advocates to transform the cancer care system for all touched by cancer, from the moment of diagnosis.  A voice for cancer survivors and their families in Washington, DC, NCCS’ vision is cancer care that supports cancer survivors and their families, that is affordable and accessible, and that considers individuals’ goals and values.

NETWORK Lobby for Catholic Social Justice is a Catholic leader in the global movement for justice and peace, educates, organizes, and lobbies for economic and social transformation.

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