Government & Politics

How to Cover the Sick

Let's take a look at the Republicans' proposed solution for the sick — "individual high-risk pools."

Lewis Morris · Apr. 12, 2017

As Republicans begin their next pass at crafting an effective replacement to ObamaCare, the debate continues to rage over how to handle high-risk insurance consumers. So let’s take a look at the proposed solution — “individual high-risk pools.”

The term high-risk pool has been thrown around a lot during the health care debate, and in some cases, has lost its true meaning. Essentially, high-risk pools provide a way for insurers to handle their sicker customers, such as those who are older or have pre-existing conditions.

Insurers can deal with their high-risk groups in different ways. One is to provide coverage for the high-risk group that is different from what other groups might receive in the broader insurance market. This can mean higher premiums or different types of coverage altogether. Another option is to shift premium revenues from those without great need to those at high risk. There is also public reinsurance, which puts taxpayers on the hook to assist in covering high-risk groups.

This brings us to the invisible high-risk pool mentioned above. This concept has taken on new life after an amendment approved by the House Rules Committee called for $15 billion to help fund it. It calls for creating one large pool in which insurers would submit their high-risk customers along with much of the premiums they pay.

A study released last week commissioned by the Foundation for Government Accountability claims that $15 billion will fall woefully short in funding the invisible high-risk pool. This funding is expected to last until 2026, but the study claims that the pool would need anywhere from $35-200 billion over the next decade.

The pool also calls for states to actively participate in order to access any of the funds for emergencies. States are welcome to go their own way in creating a high-risk pool, but they won’t see any of the taxpayer-subsidized fund if they do.

High-risk pools will be essential to any comprehensive health care package. It’s the best way to accommodate people with expensive conditions and treatments, but it may be better to let the states come up with their own solutions. The one-size-fits-all solution that Washington seems to be obsessed with is what got us into this mess in the first place. Creating a national high-risk pool for insurers when they can’t even operate across state lines is not only inherently anti-federalist, it could lead to price manipulation and manmade market fluctuations that could further jack up the cost of insurance.

Another potential problem is that to gain support for the amendment, its drafters left a lot of the details to be sorted out later as to what the final invisible pool would look like. Health care reform could be passed before anyone has a sense of how the invisible high-risk pool will operate.

Does that mean we have to pass the bill so that we can find out what’s in it? Is history repeating itself?

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