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Realizing Health Reform’s Potential: Why a National High-Risk Insurance Pool Is Not a Workable Alternative to the Marketplace
Hall, Jean P.
Hall, Jean P.
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Abstract
The Pre-Existing Condition Insurance Plan (PCIP) was a national
high-risk pool established under the Affordable Care Act (ACA) to provide
coverage for individuals with preexisting conditions who had been uninsured for
at least six months. It was intended to be a temporary program: PCIPs opened in
2010 and closed in April 2014. At that point, those with preexisting conditions
could shop for health insurance in the marketplaces, where plans are prevented
from using applicants’ health status to deny coverage or charge more. This issue
brief draws on the PCIP experience to outline why national high-risk pools,
which continue to be proposed as policy alternatives to ACA coverage expansions,
are expensive to enrollees as well as their administrators and ultimately
unsustainable. The key lesson—and the principle on which the ACA is built—is
that insurance works best when risk is evenly spread across a broad population.
Description
Date
2014-12
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Journal ISSN
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Publisher
The Commonwealth Fund