High-risk pools that segregate persons with preexisting conditions from the broader insurance pool will increase health care costs for everyone, according to a commentary published in Annals of Internal Medicine. Reinstituting them as a state option under the American Health Care Act (AHCA) would be a huge step backward for American health care policy.
Jean P. Hall, PhD, from the University of Kansas Medical Center, Kansas City, KS, explains that historically, high-risk pools have not provided affordable or adequate coverage to persons with preexisting conditions, nor have they made the individual market affordable for others. The high-risk pool coverage that existed before passage of the Affordable Care Act (ACA) had very high premiums and deductibles and serious limits on coverage, including annual and lifetime caps. High-risk pools developed under the proposed legislation may be expected to have equally or even more stringent coverage limits, especially for health categories like mental health, substance abuse, and maternity care.
This is an important issue because more than half (51 percent) of Americans have preexisting conditions, such as cancer, high blood pressure, congenital heart problems, or asthma. Proponents of the AHCA say the persons with preexisting conditions would only be subject to medical underwriting and high-risk pool coverage if they allow their existing coverage to lapse, but the possibility is real for the millions of people with preexisting conditions who go spells without insurance every year because of job changes or periods of financial difficulty.
The author concludes that if Congress truly wants to make health insurance more affordable, funding a robust national reinsurance program would be a much more efficient and equitable mechanism.
QC NOTE HIPPA protects workers who change jobs or obtain a job and health coverage by limiting or eliminating and period of exclusion for a pre-existing condition. If you have continuous group coverage, there can be no exclusion. If not, the employer plan can only apply a 12 month exclusion of coverage for the specific pre-existing condition, not other medical issues. No such provisions apply to individual coverage other than currently under Obamacare. That is because there is a much lower chance of adverse selection under employer group plans.