Evaluation of High-Risk Pools as an ACA Replacement Strategy

Evaluation of High-Risk Pools as an ACA Replacement Strategy

One of the features of the Affordable Care Act (ACA) supported by a substantial majority of Americans is the prohibition on excluding people from coverage due to pre-existing conditions. The ACA makes this prohibition possible via the individual mandate for coverage, which assures a broad risk pool in the Marketplaces. Virtually all Republican replace strategies eliminate the individual mandate and use state-based high-risk pools as the mechanism to assure coverage of people with pre-existing conditions. Such an approach has many significant problems, including prohibitively high costs to states and to individuals seeking coverage, especially individuals with incomes below 400 percent of federal poverty level. This project will document current Republican replace strategies and their specific provisions regarding high-risk pools, explore existing and possible alternatives including state 1332 waiver applications, and provide timely information and recommendations to policy makers at the state and national levels considering changes to the ACA's Marketplaces.


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