摘要：State health insurance high-risk pools are a key component of the US health care system's safety net, because they provide health insurance to the “uninsurable.” In 2007, 34 states had individual high-risk pools, which covered more than 200 000 people at a total cost of $1.8 billion. We examine the experience of the largest and oldest pool in the nation, the Minnesota Comprehensive Health Association, to document key issues facing state high-risk pools in enrollment and financing. We also considered the role and future of high-risk pools in light of national health care finance reform. STATE HIGH-RISK POOLS ARE an important component of the US health care system's safety net and will be needed as access expansions are phased in under national health care reform. In 2007, 34 states had individual high-risk pools providing health insurance coverage to 201 047 people at a total cost of $1.8 billion. 1 High-risk pools have extended coverage to those with preexisting health conditions who do not have access to affordable employer-sponsored insurance, do not qualify for public assistance, and have not been able to secure affordable coverage in the individual market because of their health status. Plan eligibility requires individuals to demonstrate that they either have been denied coverage in the private market or were offered coverage with an excessively high premium. As of this writing, the 15 states without high-risk pools are Arizona, Delaware, Georgia, Hawaii, Maine, Massachusetts, Michigan, Nevada, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, Vermont, and Virginia. 1 The nation's current economic crisis amplifies the vulnerability of high-risk individuals. Increases in job loss, mortgage foreclosures, early retirement, and bankruptcies and decreases in individuals' financial assets have implications for the number of uninsured and the extent of their health care coverage needs. The current economic situation also has repercussions for states seeking to maintain existing safety net programs with decreasing general revenue dollars. The recently passed Patient Protection and Affordable Care Act of 2010 (PL 111-148) established a temporary high-risk pool to supplement state efforts to provide coverage for individuals with preexisting medical conditions until 2014, when federal access expansions will be fully implemented. 2 The temporary high-risk pool requires individuals to have a 6-month period of being uninsured before enrollment in the pool, which has subsidized premiums and limits annual cost sharing to $5950 for an individual and $11 900 for a family in 2010. We profiled one of the largest, oldest, and most expensive state high-risk pools in the nation, the Minnesota Comprehensive Health Association (MCHA, pronounced “M”-sha). We provide current information on enrollment, costs, and financing. We include a discussion of key policy issues that MCHA (and other state high-risk pools) are facing and conclude with a recommendation to develop a plan for those currently enrolled in state high-risk pools to transition into the new national model of health care access.
