After a lot reading last night into the wee hours of the morning, I have learned more about some of the Republican reasoning behind this new health care bill, H.R.1628 – American Health Care Act of 2017. Republicans are all about (1) low taxes (2) small Federal government (3) State’s rights (4) Only taking care of themselves and not their neighbors (alright, the last one is my perception).
So what does that mean for those with pre-existing conditions? While they would not be covered under the federal portion of the bill, they might be covered by their state’s “high-risk insurance pools” (that might be partially subsidized by federal funds). This is not a new concept. It’s been tried before. Guess how that went.
What do the experts say about “high-risk insurance pools?”
President of the American Medical Association (AMA), Dr. Andrew Gurman (in a statement issued May 3, 2017 about proposed changes to the American Health Care Act)
“High-risk pools are not a new idea. Prior to the enactment of the Affordable Care Act, 35 states operated high-risk pools, and they were not a panacea for Americans with pre-existing medical conditions. The history of high-risk pools demonstrates that Americans with pre-existing conditions will be stuck in second-class health care coverage – if they are able to obtain coverage at all.
Not only would the AHCA eliminate health insurance coverage for millions of Americans, the legislation would, in many cases, eliminate the ban against charging those with underlying medical conditions vastly more for their coverage.
America should not go backward to the time when our fellow citizens with pre-existing health conditions faced high costs for limited coverage, if they were able to obtain coverage at all. The AMA urges congressional leaders and the Administration to pursue a bipartisan dialogue on alternative policies that provide patients with access and coverage to high quality care and preserve the safety net for vulnerable populations.”
Paul Markovich, The Chief Executive Office of Blue Shield of California, the largest insurer on the state’s insurance marketplace (in an interview with California Healthline on May 3, 2017)
Markovich […] issued a blunt critique of the Republican health care bill, saying it would once more lock Americans with preexisting conditions out of affordable coverage. In an interview with California Healthline on Wednesday, Paul Markovich said the GOP’s American Health Care Act is “flawed” and “could return us to a time when people who were born with a birth defect or who became sick could not purchase or afford insurance.” […] “[It’s] a moral imperative” to guarantee coverage regardless of medical history. “The discrimination, whether on price or just on the ability to access insurance at all on preexisting conditions, is unconscionable. As a country, we are better than that,” he said. […Markovich] said a proposal unveiled Wednesday to add another $8 billion in the bill over five years to offset insurance costs for those patients falls far short of what would be needed. More broadly, Markovich said the GOP bill would make health insurance unaffordable for millions of Americans by significantly reducing the premium tax credits consumers rely on. He also warned that the GOP’s proposal to deeply cut Medicaid would place an “impossible” fiscal burden on states such as California, “resulting in millions more people without access to care.”
President of the American Academy of Pediatrics (AAP), Dr. Fernando Stein (in a statement issued on May 1, 2017)
Pediatricians have been voicing our opposition to the AHCA since it was initially introduced, and the current version makes an already bad bill even worse for children and families. This bill would dismantle the Medicaid program by capping its funding and eliminating the Medicaid expansion, and a new amendment adds on even more harmful policies, such as allowing insurance companies to refuse to cover those with pre-existing conditions. In short, the bill hinders states’ and families’ ability to provide and access care. These are not improvements to our health care system; they are setbacks that would have real consequences for children.
The National Physicians Alliance, Dr. Manan Trivedi (in a statement issued on April 27, 2017)
The National Physicians Alliance remains opposed to the latest health care proposal. In fact, we feel the latest amendment added makes this bad bill even worse. By stripping funding for vulnerable populations receiving Medicaid coverage, taking private coverage away from millions of families, and driving up costs for millions more this proposal continues to be very bad for our patients. However, this new version also allows states to opt out of protections by allowing insurers to charge higher premiums for those with pre-existing conditions and allowing insurers to provide low-quality coverage that does not include “essential health benefits” – like hospitalization, mental health services, and maternity and newborn care. We hope that President Trump and Republicans in Congress once again scrap this bill, and get to the real work of finding solutions to assure all Americans have high quality, equitable and affordable health care.
The nonpartisan Kaiser Family Foundation issued a statement on February 22, 2017 that explained the concept, history, and economics of high-risk pools, both state and federal. They also created a video series, posted below.
Although no two traditional state-high risk pools were identical, nearly all adopted certain common features that tended to limit enrollment of eligible individuals.7 These included:
Premiums above standard non-group market rates – All state high-risk pools set premiums at a multiple of standard (i.e., typical or average) rates for medically underwritten coverage in the non-group market; in most states the pool premium was capped at 150%-200% of market rates. Nineteen pools provided low-income premium subsidies that varied in comprehensiveness. The Oregon pool, for example, discounted premiums 95% for enrollees with income up to 185% of the poverty level, while the New Hampshire pool provided a 20% premium discount for enrollees with income below 200% FPL. 8 Other pools required people to pay the full premium, regardless of income.
Pre-existing condition exclusions – Nearly all state high-risk pools excluded coverage of pre-existing conditions for medically eligible enrollees, usually for 6-12 months. This made coverage less attractive for people who needed coverage specifically for their pre-existing conditions. In nine states, (CT, ID, MS, MO, MT, NC, OK, TX, and WY) the exclusion period was 12 months; in Colorado and Indiana it was 3 months. The Alabama pool, which was only open for HIPAA-eligible individuals, did not impose pre-existing condition exclusion periods.9
Lifetime and annual limits – Thirty-three pools imposed lifetime dollar limits on covered services, most ranging from $1 million to $2 million. In addition, six pools imposed annual dollar limits on all covered services while 13 others imposed annual dollar limits on specific benefits such as prescription drugs, mental health treatment, or rehabilitation.10
High deductibles – Most pools offered a choice of plan options with different deductibles; in 29 programs, the plan option with the highest enrollment had a deductible of $1,000 or higher; in ten states it was $5,000 or higher.
Sounds Like A Good Idea? High-Risk Pools
Kaiser Health News Video by Julie Rovner and Francis Ying May 4, 2017
List of statements urging Congress to reject this plan
- American Cancer Society Cancer Action Network, American Diabetes Association, American Heart Association, American Lung Association, Cystic Fibrosis Foundation, JDRF, March of Dimes, National Organization for Rare Disorders, National MS Society, WomenHeart: The National Coalition for Women with Heart Disease
- American Association of Pediatrics, Children’s Defense Fund, Children’s Dental Health Project, Family Voices, First Focus Campaign for Children, March of Dimes, National Association of Nurse Practitioners
- American Hospital Association
- American Public Health Association
- American Academy of Family Physicians
- American College of Physicians