As high-risk pools are front and center in the debate today around the repeal of the Affordable Care Act (ACA), the California Health Care Foundation has pulled together resources from credible sources on the topic and highlighted key takeaways.
This new analysis looked at California's experience with high-risk pools pre-ACA and found that:
"Returning to high-risk pools as separate coverage programs for those with preexisting health conditions would be a dramatic step backward, as California's history demonstrates."
An analysis of the April 26, 2017, American Health Care Act (AHCA) found that the bill's funding for high-risk pools would result in a shortfall of $2.5 billion in California alone — and almost $20 billion nationwide. These shortfall figures may be low: They assume a fairly small high-risk pool and also assume $130 billion over 10 years is devoted to the pool, including funds currently earmarked in the AHCA for other purposes.
A follow-up analysis by CAP, The Upton Amendment to the ACA Repeal Bill Will Have Almost No Effect (released May 3), includes the additional $8 billion added to the AHCA to further support high-risk pools over five years. It finds that the California shortfall remained $2.3 billion — and approximately $18 billion nationwide.
This national analysis of high-risk pools pre-ACA found that:
"The reality is that high-risk pool coverage was prohibitively expensive, and there is little evidence to suggest that the existence of such pools made coverage less costly for others in the individual insurance market."
KFF provides a range of resources on high-risk pools, as well as preexisting conditions and underwriting in the pre-ACA market and denial rates prior to the ACA.