Federalism, intergovernmental relations, and the challenge of the medically uninsurable: a retrospective on high risk pools in the states.

While relatively overlooked in health policy research and analysis, state high risk insurance pools play a notable role in contemporary health policy arrangements. Also know as State Comprehensive Health Insurance Plans, high-risk pools emerged in the late 1970s as states began to grapple with the challenges of the medically uninsured. Today, thirty-five states operate these programs. To further our understanding of health and human services administration, it is important to examine these plans, especially in context of intergovernmental health policy in the United States. This analysis provides an overview of high risk pool evolution and gives attention to forces that have shaped their development, such as model legislation, funding arrangements, and increasing federal-level interest in their use as platforms to advance national policy initiatives.