A thought....

A possible solution to the problem of having "uninsurable"/high cost patients dumped into a state-funded system, as well as having that pool grow as it becomes easier to determine who is at high risk for costly future disease, would be to have some form of an "assigned claims" system - that is, any patient deemed too high of a risk for private insurers to accept voluntarily would be placed in the pool of high risk patients, and their medical care for the year would be assigned at random to insurance companies. The state could pay a fixed premium for this care which, although obviously far less than the cost of the care which would likely be extended, would be a figure that the insurance companies' actuaries could easily utilize in assessing premiums, and the insurance companies would be effectively forced to spread the cost across their entire pool of customers.

I would suggest that the state's reimbursement should be at a level *below* the maximum premium the insurance company could charge on the open market. That is, the reimbursement should be at a fair level, but based upon a larger group of higher risk patients - with twenty or twenty-five percent of the companies' customers paying more than the state-paid reimbursement for the same set of benefits. This should avoid allowing the insurance companies to play games with their pricing so as to create an unduly high rate for the state to pay, while also serving as a disincentive for them to dump additional high risk patients into the pool of the uninsured (as it makes no sense to drop them at the maximum rate, and get them back at 80%). Patients could be assigned to insurers in accord with their market share. An additional subsidy, or sufficient advanced notice, would be provided to allow insurance companies to avoid any short-term trauma from having these high risk patients added to their customer pools.