Vance's high-risk pool health insurance plan: Will it help or harm sick patients?

During Tuesday night’s vice presidential debate, Sen. JD Vance of Ohio, the Republican nominee, vowed to protect health insurance coverage for people with pre-existing conditions while also doubling down on a proposal to place them in a so-called high-risk pool, separating them out from healthier individuals.

To many policy experts watching the debate, the two statements seemed irreconcilable — and harkened back to a time before the Affordable Care Act, which guaranteed coverage for people with pre-existing conditions, became law.

“We tried that in the past and it failed,” said Arthur Caplan, the head of medical ethics at NYU Langone Medical Center in New York City. “Anything that separates out pre-existing conditions is doomed to utter failure.”

Before the passage of the ACA in 2010, most states relied on high-risk pools to provide coverage for individuals with chronic illnesses, said Cynthia Cox, vice president and the director of the ACA program at KFF, a nonprofit group that researches health policy issues. High-risk pools were also used for people who fell into a “gray zone” category, where they didn’t have cancer or diabetes “but their kid had three ear infections in the last year and insurance could charge them a higher premium,” Cox said.

The nation’s sickest patients, like those with cancer or chronic illnesses, only represent about 5% of the population but account for more than half of all health care spending, Cox said. Due to the exorbitant cost, insurers often deemed chronically ill people “uninsurable” and would deny them coverage, she said.

“You had such a high cost condition, you just couldn’t get insurance anywhere,” Cox said.

The idea behind a high-risk pool was to provide a safety net for people with