May 4, 2017

Study: AHCA high-risk pools could be way too small

Evan Vucci / AP

Avalere Health's study on the GOP health bill reveals planned high-risk pools would cover just 5% of people with pre-existing conditions. The AHCA includes $15 billion over nine years for states to set up high-risk pools to cover these patients, and the Upton Amendment adds another $8 billion.

The numbers: Of about 2.2 million enrollees in the individual market with pre-existing, chronic conditions, that funding will only cover about 110,000.

  • Even if states decide to use another $100 billion AHCA fund solely to help cover pre-existing conditions, only 600,000 individuals would be covered. Plus, states will get to decide how they use the $100 billion, so it won't necessarily go to those patients.

Counterpoint: Republicans are signing on to this amount because they don't think that many states will opt out of requirements on essential health benefits requirements, so fewer patients will need to be covered under the pools.

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