1. Health Reform and High Risk Pools Joshua Goldberg National Association of Insurance Commissioners NASCHIP Annual Conference October 16, 2008 Savannah, GA

2. High Risk Pools High-risk pools are an important safety net for individuals unable to purchase coverage in the individual market. The NAIC has strongly supported federal funding for high risk pools. In the absence of a more comprehensive means of ensuring the availability of coverage for these individuals, high risk pools will continue to be necessary.

3. Regulatory Reform Approaches Reforms that restrict insurers’ underwriting flexibility (guaranteed issue, community rating) reduce the need for high risk pools. Mechanisms may be needed to prevent adverse selection issues.

4. Free-Market Reform Approaches Increased underwriting flexibility makes coverage more difficult for individuals with preexisting conditions. Reforms that shift individuals from the group to the individual market subject more individuals to medical underwriting. Both will greatly expand the need for high risk pools and the funds to operate them.

5. AHIP Proposal High-risk pool-like programs to provide coverage for high-cost individuals. Guarantee Access Plans rely upon state funding to reduce premiums. Where this money will come from is unclear.

6. New Roles for High-Risk Pools There may be a role for some sort of mechanism to help subsidize high cost individuals. This could take a form similar to the Idaho high risk pool’s reinsurance mechanism.

7. Joshua Goldberg National Association of Insurance Commissioners jgoldberg@naic.org (202) 471-3984