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Regulator Discusses Risk Pool Drawbacks

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Members of Congress should be wary of relying on high-risk pools for ensuring that Americans with health problems can get health coverage.

Mila Kofman, the Maine insurance superintendent, made that argument today during a hearing of the House Ways and Means Committee health subcommittee.

Kofman and other witnesses talked about the state of the private health insurance market.

The developers of some reform proposals have argued that states ought to permit health plans to use medical underwriting, then have state high-risk pools provide coverage for residents who cannot qualify for conventional coverage.

“In reality, many high-risk pools have had significant funding problems,” Kofman said, according to a written version of her remarks posted on the Ways and Means Web site.

In many cases, premiums are too expensive, waiting lists are long, limits on eligibility exclude many who need help, plan designs exclude coverage for existing conditions, or the benefits caps are unrealistically low, Kofman said.

“Although 34 states have high-risk pools, all these pools together cover less than 200,000 people,” Kofman said.

One study of 900 diabetic people with insurance problems found that 344 lived in states with risk pools but only 7 signed up for risk pool coverage, Kofman said.

“In Maine,” Kofman said, “a high-risk pool established in 1988 was closed in the early 1990s due to funding problems. Its enrollment never exceeded 450 people.”


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