High-Risk Pools Don’t Work, Have Never Worked, and Won’t Work in the Future


Even among conservative voters, Obamacare’s protection of people with pre-existing conditions has always been popular. In a recent Kaiser poll, it garnered 74 percent approval from Democrats, 70 percent approval from independents, and 69 percent approval from Republicans.

Technically, this protection is guaranteed by two different provisions of Obamacare: guaranteed issue, which means that insurance companies have to accept anyone who applies for coverage, and community rating, which means they have to charge everyone the same price. But popular or not, Paul Ryan wants nothing to do with it:

In election-year remarks that could shed light on an expected Republican healthcare alternative, Ryan said existing federal policy that prevents insurers from charging sick people higher rates for health coverage has raised costs for healthy consumers while undermining choice and competition.

….”Less than 10 percent of people under 65 are what we call people with pre-existing conditions, who are really kind of uninsurable,” Ryan, a Wisconsin Republican, told a student audience at Georgetown University. “Let’s fund risk pools at the state level to subsidize their coverage, so that they can get affordable coverage,” he said. “You dramatically lower the price for everybody else. You make health insurance so much more affordable, so much more competitive and open up competition.”

It’s true that the cost of covering sick people raises the price of insurance for healthy people. That’s how insurance works. But there’s no magic here. It costs the same to treat sick people whether you do it through Obamacare or through a high-risk pool—and it doesn’t matter whether you fund it via taxes for Obamacare or taxes for something else. However, there are some differences:

  • Handling everyone through a single system is more efficient and more convenient.
  • High-risk pools have a lousy history. They just don’t work.
  • Implementing them at the state level guarantees a race to the bottom, since no state wants to attract lots of sick people into its program.
  • Ryan’s promise to fund high-risk pools is empty. He will never support the taxes it would take to do it properly, and he knows it.

This is just more hand waving. Everyone with even a passing knowledge of the health care business knows that high-risk pools are a disaster, but Republicans like Ryan keep pitching them anyway as some kind of bold, new, free-market alternative to Obamacare. They aren’t. They’ve been around forever and everyone knows they don’t work.

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