Maryland Used as an Example in Debate Over High-Risk Pools

High-risk pools are poised to make a comeback, as they are an important element in the GOP’s American Health Care Plan, which would replace the ACA. Interest in the pools is spurred by the search for a new fountain of youth, a fountain that would gush young invincibles into employer-sponsored health care, and thereby bring the premiums down for everybody. Before the ACA, which did away with high-risk pools, 35 states had such programs in place. High-risk pools separate people with pre-existing conditions or who are very ill—whose medical costs are likely to be off-the-charts, in other words—from those who are relatively healthy.

There are skeptics, but proponents point to the success of the high-risk pool in Maryland, the Baltimore Sun reports. Many high-risk pools had fewer than 2,000 enrollees. Maryland’s pool, called the Maryland Health Insurance Plan, got good bipartisan reviews when it was in operation and had enrollment of over 20,000 people. It was one of only four state pools with an enrollment of over 20,000, the others being Minnesota, Texas and Wisconsin.

Separating the costly patients from those who accrue normal costs is relatively simple. Figuring out how to pay for the cost of care for those in the pools is where it gets dicey. Usually, the money would come from the government, but it often wasn’t enough. “The Maryland Health Insurance Plan cost people with pre-existing conditions 33% more than healthy people…,” the Sun reports.

Money for high-risk pools will be an issue in the GOP plan, as well, which allots $138 billion over five years that could be used to finance high-risk pools. That’s not enough, Karen Pollitz, a senior fellow at the Kaiser Family Foundation who served on the board of Maryland’s high-risk pool, tells the Sun.

High-risk pools can work only with a government commitment to fund them appropriately. “You just can’t do it on the cheap,” she tells the newspaper.

Up to 133 million nonelderly Americans—or about half the adult population—have a pre-existing condition. Simply getting older is a risk factor: More than 80% of Americans, ages 55 to 64, have at least one pre-existing condition, according to HHS.

Source: Baltimore Sun