High-Risk Pools for the Sick and Uninsured Under Health Reform: Too Little and Thus Too Late
- First Online:
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.
KEY WORDShigh risk pools insurance health reform patient protection and affordable care act
- 1.KFF.org. Side-by-side comparison of major health reform proposals. Kaiser Family Foundation. Available at: http://www.kff.org/healthreform/upload/housesenatebill_final.pdf. Accessed August, 2010.
- 2.Elmendorf D. Letter to Honorable John A. Boehner. Congressional Budget Office. Available at: http://www.cbo.gov/ftpdocs/107xx/doc10705/hr3962amendmentBoehner.pdf. Accessed August, 2010.
- 3.Pollack H. Stay away from that pool. New Republic. Available at: http://www.tnr.com/blog/the-treatment/more-those-high-risk-pools. Accessed August, 2010.
- 5.GAO. Health Insurance: Enrollment, Benefits, Funding, and Other Characteristics of State High-Risk Health Insurance Pools. Washington, DC: Government Accountability Office; 2009. GAO-09-730R.Google Scholar
- 6.Frakt AB, Pizer SD, Wrobel MV. High-risk pools for uninsurable individuals: recent growth, future prospects. Health Care Financ Rev. 2004;26(2):73–87.Google Scholar
- 11.Sebelius K. Letter to Congressional Leaders. Department of Health and Human Services. Available at: http://www.politico.com/static/PPM153_sebelius_051010.html. Accessed August, 2010.
- 14.McWilliams JM, Meara E, Zaslavsky AM, Ayanian JZ. Intensity of health services and costs of care for previously uninsured medicare beneficiaries. J Gen Intern Med. 2007;22:67–8.Google Scholar
- 16.DeNavas-Walt C, Proctor BD, Lee CH. Income, Poverty, and Health Insurance Coverage in the United States: 2005. Unted States Census Bureau. Available at: http://www.census.gov/prod/2006pubs/p60-231.pdf. Accessed August, 2010.
- 17.Holz-Eakin D. The uninsured and rising health insurance premiums. Congressional Budget Office. Available at: http://www.cbo.gov/doc.cfm?index = 5152&type = 0. Accessed August, 2010.
- 18.Schwartz T. State High-Risk Pools: Kaiser Commission on Medicaid and the Uninsured; January 2010 2010. 8041.Google Scholar
- 19.Merlis M. Health coverage for the high-risk uninsured: policy options for design of the temporary high-risk pool. National Institute for Health Care Reform. Available at: http://www.nihcr.org/High-RiskPools.html. Accessed August, 2010.
- 20.IOM. Public Financing and Delivery of HIV/AIDS Care. Washington, DC: National Academies Press; 2005.Google Scholar
- 21.Baucus M. Call to Action: Health reform 2009. United States Senate Finance Committee. Available at: http://finance.senate.gov/download/?id = 916b0ea3-96 dc-4c7a-bb35-241fa822367e. Accessed August 9, 2010.
- 23.Plantinga L, Crews D, Coresh J, et al. Prevalence of chronic kidney disease is high in persons with undiagnosed or pre-diabetes in the United States. Am J Kidney Dis. 2009;53(4):160.Google Scholar
- 25.Nichols AL, Zeckhauser RJ. Targeting transfers through restrictions on recipients. Am Econ Rev. 1982;72(2):372–8.Google Scholar
- 27.Pollack H. The Cost of Delayed Reform. American Prospect. Available at: http://www.prospect.org/cs/articles?article = the_cost_of_delayed_reform. Accessed August, 2010