Eliminating the Affordable Care Act and placing sick people into state-based high-risk pools would drive up state spending, deny coverage to many more people, and result in plans that do not meet the medical needs of the people who need it most.
That's according to Carolyn Long Engelhard, director of the Health Policy Program at the University of Virginia School of Medicine's Department of Public Health Sciences. Engelhard writes in The Hill that House Speaker Paul Ryan's advocacy of the triage of people with serious medical issues into high-risk pools would bring about some of the very problems he claims it would solve.
Sick people in an average insurance pool use more medical services, thus driving up the cost of coverage for everyone in that pool and causing at least some of the healthiest to drop out. That in turn drives up the cost further, causing less healthy people to drop out because they cannot afford the premiums and resulting in a very small number of people with coverage and very high costs for the people who remain.
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The ACA's efforts to avoid that through its guarantee of coverage for people with preexisting conditions, the individual mandate penalty and premium subsidies are by no means perfect; many people still lack health insurance because the premiums are too high.
However, putting all the sick people into a high-risk pool and eliminating the coverage guarantee could result in as many as 50 percent of nonelderly Americans with preexisting conditions being shut out of coverage, notes Engelhard. In addition, many of the problems encountered by state-run pools that preceded the ACA would return: high deductibles and long waiting periods before preexisting conditions would be covered, as well as high premiums.
In short, Engelhard writes, "since the ACA was set up in part to address the problems brought on by risk-rating individuals and the inadequacies of state-based high-risk pools, having the Republican leadership embrace the entity as a new strategy to ameliorate the failings of Obamacare seems risky at best and quite ironic."
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