Take Two®

News and culture through the lens of Southern California. Hosted by A Martínez

What exactly is a high risk pool?

by Take Two®

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A woman rides a pink swan floatie in the pool of the Ace Hotel in Palm Springs. Flickr user Carlos Pacheco/Creative Commons

It's one of the major elements of the GOP-backed healthcare bill.

The idea is that states should be responsible for people with pre-existing conditions who also want health care coverage.

To do that, they would create what's called a high risk pool.

The best way to understand how that works is imagining a real-life pool – the kind with water.

Pretend you're at a pool party with music pumping and beach balls flying.

A bunch of your friends and family are splashing around in there with you. Maybe you also invited some coworkers that you actually like.

Let's say many of you are good swimmers. In the health care pool, those same people are the healthiest and rarely need help.

But then you all notice someone in the deep end who's struggling to stay afloat.
 
At the party, he's a bad swimmer. In real life, maybe he has a life-threatening illness.
 
So you do what friends do – everyone else in that pool paddles on over to help him keep his head above water.

With more good swimmers nearby, the easier it is to help.

That's sort of how insurance pools work, too: healthy people are there to pay into the system, and that holds costs down for everyone.
 
Some people might argue that in the pool – the water one – good swimmers may not get to spend as much time in the deep end splashing around because of having to look out for bad ones.

In health insurance, they're paying more to cover the costs of treating those who are sicker.
 
This is where the idea of a high risk pool comes in.
 
Imagine instead of just one party, there were two.

You were hosting one where you only invited the Michael Phelpses and Esther Williamses of the world.

But then your cousin – a bad swimmer – shows up and he immediately starts flailing in the water.

This time, no one wants to deal with him. So you say, "Hey, can you go wade in the pool across the street??
 
That's the high-risk pool and it's full of people like your cousin – nobody in this pool can swim well.

It does has a few lifeguards, however, gazing out from the edge who, can help out everyone.

In health insurance, those are government subsidies which help to cover the extra costs.

But obviously, it's easier for a few bad swimmers to get help from a big crowd of good ones in the same pool as opposed to a handful of lifeguards watching a bunch of people who can barely keep their heads above water.

Now, that's in this scenario of a pool party.

In the real world of health care, however, will people stay afloat in high-risk pools … or be sunk?

 

 

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