Trump's running mate revives debate about high-risk pools for pre-existing conditions

Sen. JD Vance, the Republican nominee for vice president, recently implied that a new Trump administration could replace the current Affordable Care Act framework with a system that would use high-risk pools, or special insurance programs for people with health problems, to provide coverage for people with preexisting conditions.

“We want to make sure everybody is covered,” Vance said in an appearance on NBC’s “Meet the Press. “But the best way to do that is to actually promote some more choice in our health care system and not have a one-size-fits-all approach that puts a lot of people in the same insurance pools, into the same risk pools. That actually makes it harder for people to make the right choices for their families.”

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Vance, who represents Ohio in the Senate, said Trump wants to “make sure that people have access to the doctors that they need” and also “implement some deregulatory agenda.”

Kamala Harris’s analysis: The campaign of Vice President Kamala Harris, the Democratic presidential nominee, has assumed that a new Trump administration would try to move ahead with a system based on a return to medical underwriting for individual health insurance and use of risk pools to provide coverage for people with health problems.

“Experts agree that Trump’s repeal of the Affordable Care Act would be devastating,” The Harris campaign says in an analysis of what the campaign contends is Trump’s health policy proposal,

It cites an Urban Institute prediction that full ACA repeal would increase the number of uninsured people by 21 million to 24 million and an American Hospital Association prediction the full ACA repeal would leave “patients without access to everything from routine checkups to treatment for chronic illnesses.”

The campaign shows state-by-state AARP Public Policy Institute estimates of how full ACA repeal would have affected average out-of-pocket coverage costs for 60-year-olds who qualified for ACA premium tax credit subsidies if the ACA had been repealed in 2020.

For a 60-year-old who could still get individual coverage without the ACA, out-of-pocket coverage costs would have increased to an average of $12,180 per year, from $1,608, according to the impact estimates.

A return to the old, pre-ACA rules could force some would-be entrepreneurs to stick with their current employers, simply to have access to health coverage, and workers with coverage might face a return to having annual and lifetime limits on what their health plans will cover, according to the Harris campaign.

Donald Trump and JD Vance “will rip away people’s coverage, including people with preexisting conditions,” the campaign says.

An ACA system critic: Brian Blase and other analysts at the Paragon Health Institute, an independent research center started by economists who worked in the White House while Trump was president, have argued that the Affordable Care Act has turned the individual major medical insurance market into what amounts to a very expensive, heavily subsidized, risk pool program that encourages the enrollees to lie about their income.

“Proposals to improve the status quo should be welcomed, given the deep underlying problems with the Affordable Care Act,” Blase says in a commentary about the idea of a return to medical underwriting.

Cash-for-coverage programs: For some benefits brokers and their clients, the idea of increased use of medical underwriting might sound like a good way to hold down costs.

For the plan administrators and employers that are starting to develop the individual coverage health reimbursement arrangement and qualified small employer HRA markets, a return to unlimited use of medical underwriting, without any guaranteed access to coverage or limits on premiums for people with preexisting conditions, could cause problems.

ACA underwriting restrictions made offering ICHRA and QSEHRA programs practical, by giving employers a way to offer “cash for coverage” programs that could provide coverage for employees and dependents with hea

The new HRA market: For benefits brokers and their clients, the idea of increased use of medical underwriting might sound like a good way to hold down costs.

But a return to unlimited use of medical underwriting, without any guaranteed access to coverage or limits on premiums for people with preexisting conditions, could cause problems for the plan administrators and employers that are starting to develop the individual coverage health reimbursement arrangement and qualified small employer HRA markets.

ACA underwriting restrictions made offering ICHRA and QSEHRA programs practical, by giving employers a way to offer “cash for coverage” programs that could provide coverage for employees and dependents with health problems as well as healthy employees and dependents.