Lawmakers seeking to replace the Affordable Care Act (ACA) are contemplating creating high-risk pools. Unlike under the ACA, in which healthy and less well consumers are insured in the same groups, this approach would establish a group that includes only those consumers with preexisting conditions. High-risk pools lack a track record of success despite being tested many times over, by a variety of states and in the early stages of implementation of the ACA. The evidence from those experiments is clear: high-risk pools do not work, and have historically resulted in very high premiums and onerous terms for the coverage that fail to provide the care consumers need.