The High Risk of High Risk Pools

At Bloomberg Politics Sahil Kapur cuts through the ennui surrounding Republican alternatives to Obamacare by focusing on one red-hot issue where the GOP is not necessarily on the same page: whether and how to cover people with pre-existing conditions, a central element of the Affordable Care Act.

Knowing this coverage polls extremely well, but obviously not being willing to provide for the kind of redistribution of resources from the healthy and wealthy to the sick and poor that Obamacare conducts, most Republicans intone “high-risk pools” and move on. These pools, which already existed in 20 states before ACA, basically offer last-recourse individual insurance policies with terrible coverage at high cost. But even this band-aid, notes Kapur, could get ripped off by conservatives:

[T]here’s a major problem with this idea: Republicans in Congress have refused to spend even a fraction of the money that conservative experts say is necessary to make the plan work. In fact, a 2013 attempt by House Republican leaders to fund high-risk pools went down in flames.

That’s an allusion to Eric Cantor’s aborted attempt to show House Republicans were eager to help people with pre-existing conditions while messing with Obamacare by killing off an ACA wellness fund and moving the money into a temporary fund designed to create state-run high-risk pools that were a bit better than what was previously available. The clever trick backfired when House Republicans, egged on by conservative activist groups, opposed the bill.

Kapur’s memory is that the high-risk pool scheme’s cost was the main problem. I seem to recall that it was the use of an Obamacare provision to tell the states what to do that was the bigger issue. Either way, Kapur’s right: Republicans embracing this shopworn idea had better be careful about how they structure and pay for it. High-risk pools are not much help unless an extraordinary amount of money is poured into them to subsidize coverage. And many, perhaps most, GOPers don’t want to spend tens of billions of dollars a year on an afterthought driven by polling data.

Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.