Using a conceptual bio-physical/social systems model, this national study of Severe Repetitive Loss (SRL) flooding investigates cost and loss trends, the descriptive characteristics of these geographies and populations, both now and in the future. It also assesses the effectiveness of the Community Rating System and its policies in dealing with these repetitive natural hazards. Descriptive findings demonstrate that SRL properties in both very-high and high-risk coastal and non-coastal areas are increasingly at greater risk in terms of both absolute losses and property damage. Coastal areas are increasingly populated by white, middle-class households and have experienced extraordinary population increases over the last 30 years. Non-coastal areas tend to be more diverse both demographically and in terms of income. With few exceptions, the median income of vulnerable populations in both coastal and non-coastal areas tends to be lower than the national average. Based on a future risk assessment, those communities more likely to be impacted from future flooding vary, as payouts per capita and median income are positive and significantly related in coastal and major river areas, while negatively correlated near creeks and other non-coastal areas. Overall, the impacts of severe repetitive losses are felt by disparate groups as a function of ecology, society and economics. Program and policy findings include: the CRS program effectively mitigates per capita losses overall, though certain policies are more effective, significantly lowering losses in these areas. These effective policies share some common characteristics as they tend to mimic ongoing ecological processes, prove collective in scope and nature (whether it is manufactured home park or stormwater regulations) and require action and investment at larger scales. Regulations that target individual homeowners prove significantly correlated with increased losses. Policy recommendations include targeted policy changes and programmatic responses based on three criteria: ability to pay, risk/vulnerability and governance capacity. These recommendations include (1) Elimination of insurance support or lowering of premium subsidies based on ability to pay; and (2) The creation of targeted mitigation programs in high-risk neighborhoods and municipalities. These programs should incorporate identified "effective" CRS policies.