High-Risk Pools Under the AHCA

A hospital doctor checks a young girl using an auriscope.

Analysis finds estimated cost of high-risk pools is three to five times AHCA funding, depending upon design.



The Issue

The AHCA allocates a maximum of $128 billion in government funds over nine years, but even the least expensive high-risk pool option modeled in the report would cost the government $359 billion over 10 years if all states set them up.

Key Findings

  • Between 2.5 million and 7.6 million people could be eligible for a high-risk pool under the AHCA.

  • If the lowest government cost option modeled was taken, an estimated 6.2 million high-medical-need people would remain uninsured under the AHCA.

  • The least restrictive option modeled would cost the government $656 billion over 10 years.

  • The median high-risk pool enrollee would spend 8 percent to 10 percent of income on health care under the Affordable Care Act-like (higher government cost) approach, while the median enrollee under the more traditional (lower government cost) high-risk pool model would spend 35 percent to 41 percent of income on health care.


Researchers find that the federal funds allocated in the AHCA would not be enough for insuring high-need individuals through high-risk health insurance pools.

About the Urban Institute

The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research.