High-Risk Individuals
There are circumstances when an individual without access to group coverage cannot obtain health insurance because he/she is a medical high risk or already has a chronic health condition. Fortunately, the fraction of non-elderly uninsured persons who are not institutionalized and who would be rated as actuarially uninsurable is generally estimated to be very small, less than 1 percent of the population. (Mark Pauly, Health Affairs)

In addition, there are individuals who have an illness, but still can obtain a policy. However, it may come with a higher premium, exclusions, or long waiting periods. For those who have adequate income this is not a problem, but for those with modest or low incomes these restrictions may present a significant barrier for coverage. Studies show that most people applying for coverage in the individual market are offered coverage (88%), and 71% are offered coverage at standard rates. A small number are rated up (5.9%) and 14% are issued coverage with riders. Only 3% are offered coverage with both riders and extra premiums.

Regardless of the number, people who are sick, uninsured, or unable to secure health insurance should have help. CAHC members support full funding of existing State High Risk Pools and the creation of risk pools in states that do not have one. Not only will they be able to get coverage, but also the cost of coverage in the high-risk pool is limited, making it more affordable. This should help reduce the growing number of uninsured in America.

NASCHIP State Pool Membership for 2007

Source: National Association of State Comprehensive Health Insurance Plans (NASCHIP)

Learn more about how high risk pools work and how they help a vulnerable population.

See what legislation Congress is considering to help expand and strengthen high-risk pools.