Enrollment In Alabama’s High Risk Pool Increases Six-Fold

One of the things Americans like most about the Affordable Care Act is that insurance companies can no longer deny people coverage because of a pre-existing condition like cancer or diabetes. That provision will take effect in 2014, but in the meantime, individuals and families with pre-existing conditions can enroll in temporary high-risk insurance pools that provide coverage for those who are can’t find insurance elsewhere.

Since large groups of sick people are very expensive to insure — they spend the premiums they pay into the risk pool — enrollment has lagged behind expectations, as high risk pools attracted the sickest (and more desperate) individuals willing to pay a hefty price for coverage. But since the federal government instituted a series of reforms, enrollment has picked up. In Alabama, for instance, the size of the state’s pool increased six-fold over the last year, when premiums were cut by 40 percent. Other states also saw tens of thousands more Americans join their state’s pools:

The U.S. Department of Health and Human Services reports that as of the end of February, 389 people in Alabama were on the special insurance, an option for people with illnesses that make them a high risk, such as cancer or diabetes. Last February, there were 61 enrollees. […]

Alabama’s uptick in enrollment follows a national trend over the last 12 months, when enrollment grew from 12,437 to 56,257. The plans are for people who have been denied coverage because of their health status and are struggling to find affordable insurance. To qualify, people must have gone without health insurance for six months and not be eligible for Medicaid or Medicare.


“For too long, Americans with pre-existing conditions were locked out of the health care system, and their health suffered,” HHS Secretary Kathleen Sebelius said in a recent prepared statement. “Thanks to health reform, our most vulnerable Americans across the country have the care they need.”

Alabama is far from alone in seeing higher enrollment. According to the National Conference of State Legislatures, 49 states, plus Washington, DC, saw an increase in enrollment in their high-risk pools last year. (The lone outlier, Vermont, was not listed as having any enrollees in its pool, but is a “guaranteed issue state” which offers policies to all eligible applicants regardless of their health.) The federal government’s contribution to the program — $5 billion — is running out fact, but given the new enrollment numbers, the law is clearly having an impact.

-Zachary Bernstein