Abstract
While health insurance tax credits could help people who otherwise could not afford to purchase coverage, many might still find individual coverage too expensive and its marketplace dynamics bewildering. As an alternative, this paper outlines an approach using private purchasing pools for tax-credit recipients. The objective is to offer these individuals and families a choice among competing health plans, and provide many of the same advantages enjoyed by workers in large employer groups, such as relatively low administrative costs, no health rating, and an effective “sponsor.” Some express optimism that private pools will emerge naturally and thrive as an option for individual tax-credit recipients. However, adverse selection and other individual health insurance market forces make this a dubious prospect. The approach presented here gives purchasing pools the same tool employer groups use to maintain stability and cohesion—a significant contribution that cannot be used elsewhere. The ability to offer health plans exclusive access to a sizable new, previously uninsured clientele—tax-credit recipients—would enable purchasing pools to attract health plan participation and thus overcome one major reason several state-directed pools for small employers have failed. To avoid other pitfalls, the paper also suggests private pool structures, as well as federal and state roles that seek to balance objectives for market innovation and choice with those for coverage-source stability and efficiency.