WASHINGTON, D.C. – The $23 billion allocated for certain people with pre-existing conditions under the American Health Care Act might not be enough to fully cover the necessary 2.2 million people.
The U.S. House of Representatives narrowly passed a bill May 4 that paved the way to repeal and replace the Affordable Care Act. Congressman Scott Tipton, R-Cortez, voted for the bill, and said in a news release that he is fulfilling his promise to drive down costs of health insurance and to bring more competition into the market.
“As the House developed the American Health Care Act, I was adamant that the replacement plan needed to ensure people with pre-existing conditions would have access to affordable health insurance,” Tipton said.
Liz Payne, Tipton’s spokeswoman, said the bill ensures that no insurance company can deny coverage to anyone with a pre-existing condition.
While that is true, the GOP health care bill would allow states to seek a waiver for insurance providers in the individual market under certain circumstances. The state must set up a program to cover the most costly patients, such as a high-risk pool, where the government and insurance companies all share the cost of their care.
States that don’t seek waivers would be tied to the community rating regulations, which prevent health insurers from discriminating on health, age or gender in a geographic area.
New research from Avalere Health, a Washington, D.C.-based medical consulting firm, showed that funding for high-risk pools would cover only about 110,000 people with pre-existing conditions. The firm estimated that about 46,000 Coloradans have pre-existing conditions.
Payne said in an email that because the amendment would only relate to those who had a 63-day lapse in coverage, the smaller number of people in the high-risk pool would be more manageable.
Kaiser Health News reports that high-risk pools in the past have not worked well, and the cost of insurance remained out of reach for many.
“Before the Affordable Care Act, 35 states had high-risk pools,” a Kaiser report says. “The federal government had one, too, as a transition to the health law.”
“Both premiums and other costs remained too high for many people with health conditions to afford,” the report says. “The federal program ran out of money almost a year before it was scheduled to end.
“Sometimes the pools got so expensive for states that they had to impose waiting lists for coverage.”
The waiver was a last-minute amendment added to allow insurance companies to charge patients more if their coverage lapses for more than 63 days.
“The risk-sharing model would be meant for individuals who have not maintained continuous coverage,” Payne said.
The amendment was one of two that helped pass the bill with support from the conservative Freedom House Caucus.
Colorado had its own high risk pool, called CoverColorado, from 1991 to 2014 – before Obamacare. But it wasn’t sustainable, the state’s former insurance commissioner, Marcy Morrison, told The Denver Post.
The premiums were as much as 50 percent higher than the market average and covered only about half the CoverColorado’s expenses, Morrison told the Post. The difference was made up with contributions from the state’s unclaimed property fund and charges to every other health insurance customer in the state, the Post reported.
And the plan had a $1 million lifetime benefit cap, and enrollees had to wait several months for benefits on pre-existing conditions.
The U.S. Health and Human Services Department projected that up to 17.9 million people living with pre-existing conditions were uninsured in 2010.
Michael Bennet, D-Colorado, said in a news release last week that the House bill is taking the country in the wrong direction.
“This misguided approach would cause hundreds of thousands of Coloradans to lose their coverage, with those in our rural communities hit the hardest,” Bennet said.
Bennet said in a committee that not enough of the health care system seems to be patient-centric.
“Really this is about the patients and having the patient not fighting to get the care they need when they need the care,” Bennet said.
Josephine Peterson is a reporting intern for The Durango Herald in Washington, D.C., and a recent graduate of American University. Reach her at firstname.lastname@example.org and follow her on Twitter @jopeterson93.This article has been updated to clarify that states could seek waivers for providers in individual markets under certain circumstances.