Health Insurance Values » Legislation

Risk pools for the
medically uninsurable

State-sponsored risk pools are aimed at a small slice of those Americans who have the means to pay for health insurance, but are denied coverage by private companies because of a pre-existing medical condition.

A majority of people — nearly 60 percent, according to the U.S. Census Bureau — get health care through their employer under group health insurance programs. Another 27 percent of the population is covered by government-sponsored health care through Medicaid, children’s health care programs, military health care, native American health care programs and various state programs for low-income people.

Those left over are the self-employed or those working for very small companies that do not provide health insurance benefits. If that describes you, you must purchase coverage directly through private insurance companies. If you and your family have always been healthy, you’ll be able to pick from a variety of plans, with various benefits and costs, available in your state. However, if you’ve already had any medical conditions, or other high-risk factors, you may be unable to find a health insurance company that will offer you comprehensive health insurance at any price.

Risk-pools to the rescue
First established in Minnesota in 1976, these plans pool together all of the individuals declined coverage by private insurance companies. They provide them with the option to buy into a state-sponsored health insurance plan, albeit at a higher cost than if they were able to qualify for a private plan. Currently 34 states offer some form of risk pool, covering about 183,000 people. That may not seem like a lot when you look at America’s total number of uninsured, but for many people it’s the difference between being stuck in a dead-end job to keep its benefits and switching to jobs that are better for your family or becoming self-employed.

Some do an excellent job in providing alternatives for their citizens, while others do very little because their plans are not well-designed, not properly funded or simply unaffordable. At their core, risk pools are state-created, nonprofit associations that — in most states — do not require tax dollars to operate. The risk pools can be a temporary stopping point for individuals who are denied health insurance for medical reasons. Risk pools often help individuals fill a gap in insurance coverage.

How to find risk pools
The National Association of State Comprehensive Health Insurance Plans (NASCHIP) provides educational opportunities and information for state high-risk insurance pools. Most states have high-risk pools; here is a state-by-state list of resources.

High-risk pools

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