January 17, 2017 5:30 pm -

As in $178.1 billion a year for high risk pools.

“They’re not affordable and they’re not very comprehensive in the way marketplace coverage is,” said Jean P. Hall, the director of the Institute for Health and Disability Policy Studies at the University of Kansas who has authored a number of studies on high-risk pools.

“Ultimately [the cost] comes out of the pocket of the individual who is covered by it,” she said…


The challenge is subsidizing them, as segregating the most costly individuals into their own pool means that the average cost is going to be, well, very costly. The average net loss per enrollee in states with high-risk pools in 2011 was $5,510.

A Commonwealth Fund study estimated in 2014 that it would cost the federal government $178.1 billion per year to fund a national high-risk pool program that would cover the Americans barred from insurance due to pre-existing conditions prior to the ACA. Health care experts at the right-leaning American Enterprise Institute pegged that number to be smaller — between $15 and $20 billion dollars annually– but for a program that would only cover 3 or 4 million people nationwide, and assumed a cost-model of the state-based programs that included the coverage restrictions.

The Obamacare replacement plan offered by Price, Trump’s pick for Health and Human Services secretary, carved out a mere $3 billion over a three-year period (or $1 billion per year) to fund high-risk pools for consumers who can’t get insurance due to pre-existing conditions. Ryan’s own proposal was only a little more generous, offering $25 billion over a ten-year period or $2.5 billion per year.



D.B. Hirsch
D.B. Hirsch is a political activist, news junkie, and retired ad copy writer and spin doctor. He lives in Brooklyn, New York.