Journal of General Internal Medicine

, Volume 26, Issue 1, pp 91-94

First online:

High-Risk Pools for the Sick and Uninsured Under Health Reform: Too Little and Thus Too Late

  • Harold A. PollackAffiliated withSchool of Social Service Administration, University of ChicagoCenter for Health Administration Studies, University of Chicago Email author 

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Democrats and Republicans have turned to the concept of “high-risk pools” to provide health care for those Americans who face the dual challenge of uninsurance and serious health difficulties. Under the Patient Protection and Affordable Care Act (PPACA), these “high-risk” individuals will receive extensive help and regulatory protections, in concert with a new system of health insurance exchanges. However, these federal provisions do not become operational until 2014. As an interim measure, PPACA provides $5 billion for temporary, federally funded high-risk pools, now known as the Pre-Existing Condition Insurance Plan (PCIP). This analysis explores the adequacy of such funding. Using 2005/06 data from the National Health and Nutrition Examination Survey (NHANES), we find that approximately 4 million uninsured Americans have been diagnosed with emphysema, diabetes, stroke, cancer, congestive heart failure, angina, or a heart attack. To provide adequate health care for uninsured individuals with chronic diseases, the federal PCIP appropriations would need to be many times higher than either Democrats or Republicans have proposed.


high risk pools insurance health reform patient protection and affordable care act