Officials from Intermountain Healthcare and University of Utah Health Plans met with Utah lawmakers in August to recommend the state bring back a high-risk pool to Utah’s health insurance market as a way to remedy some of the difficulties caused by the Affordable Care Act.
Greg Poulsen, Intermountain’s Senior Vice President and Chief Strategy Officer, was among those who spoke at the legislature’s Health and Human Services Committee meeting on August 23. “We recommend recreating the concept of a high-risk pool around those with very, very high but predictable expenses,” he told committee members.
By removing patients with the predictably long-term highest medical costs from the individual market insurance exchange, Poulsen said premium costs for everyone else buying insurance on the exchange would drop significantly. That in turn would entice more young and healthy people to buy insurance on the exchange, which Poulsen said is necessary to make the marketplace sustainable. People in the high-risk pool would have their higher expenses subsidized by the government using funds already provided through the Affordable Care Act.
Rep. Robert Spendlove, R-Sandy, the possible sponsor of a bill to revive Utah’s high-risk pool, told The Salt Lake Tribune: “By creating a high-risk pool, we’ll be able to better address the unique health struggle of people [with pre-existing conditions and high care costs], while also doing a better job of controlling costs overall.”
High-risk pools existed in Utah before the Affordable Care Act, but they had some problems, including caps on the amount of assistance enrollees could receive. Poulsen said the reallocation of federal resources already being spent in the exchange would provide the additional funding needed to give people in the pool all the care they need.
Poulsen said the pool would also incentivize insurers to give high-risk patients more resources to better manage their health. “Not only are they not second-class citizens, they’re in fact elevated, essentially, to the head of the class because an insurer who has responsibility for them knows that by keeping them as healthy as possible, they can save huge amounts of money.”
The Trump administration has given state officials an open invitation to experiment with high-risk pools, and says the pools can use federal and state tax dollars to help pay for insurance claims. Any move to reestablish high-risk pools in Utah would have to be passed by the Utah Legislature.