The committee report found that the insurance companies turned down one out of every seven applicants with pre-existing conditions. Such denials had jumped by nearly 50 percent between 2007 and 2009, as the apparently successful financial strategy gained sway.

In the pre-Affordable Care Act era, states that ran high-risk pools generally specified pre-existing conditions that automatically qualified patients for admittance — generally serious diseases like AIDS, diabetes or epilepsy. The determination was based on health, but patients who could show they had been turned down by insurers were also generally eligible. Insurers, with different motivations, draw very different boundaries. In interviews with Dr. Hall before the A.C.A., some Kansans said that merely having hay fever or being fat were enough to be placed in the pools.

Indeed, if insurers make the call about who to exclude, almost anyone who needs insurance would seem vulnerable. I’m by all measures really healthy but I, too, once had an abnormal Pap smear, have taken Lexapro for short periods of my adult life and very occasionally use an asthma inhaler before I exercise in winter. Since an orthopedist removed the cartilage in my right knee after a soccer injury in college (an operation that has since been deemed useless or harmful), odds are that I will someday need a knee replacement. Dr. Hall told me that surgery alone could throw me into a high-risk pool, by many insurers’ standards.

And what of the much vaunted benefits of cancer screening? With the possibility of a poorly financed high-risk pool looming, a rational person might avoid a colonoscopy. A polyp removal might prevent cancer but could mean paying higher insurance rates, because patients who get polyps are at risk for developing more polyps, which can be precursors to cancer.

We all have — or will have — some kind of a problem in our medical history.

Today, Mr. Albert, 52, is not happy with the price of his family’s high-deductible Obamacare policy: $2,000 a month. Even so, he said: “The A.C.A. was a lifesaver for us. Everyone in my family has something that could be defined as a pre-existing condition. It’s expensive but I don’t have to worry about being excluded from insurance or about bankruptcy anymore.”