When Obamacare was first proposed its main stated purpose was to provide coverage to those with pre-existing conditions who could not obtain health insurance in the private insurance market. This was highly publicized, promoted and ultimately propagandized. Finally someone would force those evil insurance companies to cover the sick! You might recall Obama ranting about insurance company CEO salaries and telling many bleeding heart stories about people being denied coverage by private insurance companies. These emotional stories painted insurance companies as the bad guys and tugged at the heartstrings at millions of Americans who were duped into supporting Obamacare.
There is one thing that wasn’t talked about. High Risk Pool Plans. Write those 4 words down because if the Republican party is to ever successfully repeal Obamacare they will have to replace it with a provision that covers pre-existing conditions and High Risk Pool Plans should be (and most likely will be) a key component of their argument for an Obamacare replacement.
So what is a High Risk Pool Plan? Well first off 33 states already had them BEFORE Obamacare….that’s right BEFORE Obamacare. In my home state of Wisconsin our High Risk Pool Plan was called HIRSP. Since 1979 this plan provided coverage to the same people Obama talked about who weren’t able to obtain coverage from private insurers. The program also provided subsidies to individuals making less than $34,000 per year. So HIRSP had been providing coverage for those pre-existing conditions for 31 years BEFORE Obamacare passed and with low income subsidies to boot! Throw in the fact that HIRSP members were allowed to visit any doctor in Wisconsin and most of the people on the program were very satisfied with it. Many clients I know that I sold the HIRSP plan to (licensed agents were also able to sell the plan for a small commission) were upset when the program announced it would be ending at the close of 2013 due to Obamacare. They would now have to enroll in network based plans on the exchanges with smaller provider networks due to the fact that larger insurers like United Healthcare & Humana declined to participate in Obamacare exchanges. This would mean the likelihood of being able to keep their doctors would become slim at best. What happened to “if you like your doctor you can keep your doctor. if you like your plan you can keep your plan.” I guess maybe Obama had his fingers crossed? In reality, to solve the pre-existing conditions problem, if 33 states already had High Risk Pool Plans, shouldn’t Obama and the Democrats simply have block granted money to the 17 states that didn’t have a High Risk Pool Plan? Wouldn’t that have been much easier and less costly and disruptive for everyone involved? Of course it would have, but Obamacare was never intended to “fix” anything.
This leads me to my next point. Many people ask me what about Obamacare has caused premiums to rise to unnaturally high levels? It is pretty simple really. There is no longer underwriting allowed in the non-Medicare major medical insurance market. Insurance companies cannot deny, charge more for or rider any pre-existing conditions for applications with a January 1, 2014 effective date or later. Knowing this was going to be the case, insurance companies adjusted their risk levels to include covering costly procedures for those with pre-existing conditions in preparation for Obamacare’s implementation for the past several years which caused premiums to rise faster and higher than they did in the past. Under the law someone with a pre-existing condition like say…heart trouble…could wait until the day they need triple bypass surgery to buy insurance and then cancel it the day after the operation. So in this case, the insurance company collects 1 month’s premium and shells out hundreds of thousands of dollars to cover the surgery. Same goes for pregnancies, wait until the day you’re in labor to buy and then cancel the day after the baby is born. Unlike with Medicare plans, there is no “lock-in” provision that forces people to stay enrolled for at least a year and there are no waiting periods allowed for procedures to be covered. What else did people expect them to do other than raise premiums on everyone to cover these losses? Other factors include cuts to Medicare Advantage, where many insurers make the bulk of their money providing quality care to the poorest and sickest seniors and disabled and new taxes on insurance companies and medical device makers which raise the cost of covering durable medical equipment.
Ok so now that we’ve established how terrible and flawed this law is and how it appears to have been set up to fail and ultimately lead to a single payer system in the socialist dreams of the Democrats after future public outcry over high premiums, what alternative to Obamacare can Republicans present that includes coverage for those with Pre-existing conditions that DOESN’T include ruining the rates for everyone else’s insurance?
THE AMERICAN HEALTHCARE REFORM ACT
This bill re-instates former High Risk Pool Plans and expands them so that EVERY AMERICAN IN EVERY STATE would have access to them. So there you have it. Pre-existing conditions would be covered for everyone. The entire argument over this would be ended because Obamacare’s sole purpose would no longer have a purpose. The American Healthcare Reform Act has so many cost reduction measures in it that put side by side next to Obamacare, would be a no-brainer for any consumer. It would be like me selling a plan to someone with better benefits for less money (something I do quite often!). This bill not only covers pre-existing conditions with a cap on premiums for high risk pool plan members, but it implements meaningful medical malpractice reform (tort reform), expands health savings accounts, removes barriers to purchasing insurance across state lines (creating more competition, thus driving premiums down) and allowing for sole proprietors and small businesses to pool together to purchase group insurance so that they can enjoy the same premium advantages as big businesses.
Currently this bill is stuck in a committee in the US House of Representatives. It has 86 co-sponsors (all Republicans). Contact your congressional representative and tell them to get behind this bill and start talking about it!! Repealing Obamacare is essential but replacing it with something that addresses the original issues with the old system is even better!
Track the bill and see current co-sponsors here….