Obamacare Repeal: What May Replace It
High-Risk Pools continued...
“If the sick people keep getting moved out and are in the high-risk pool, you don’t share in their cost,” she says.
Cons: Coverage in high-risk pools was very expensive, says Sabrina Corlette, research professor with Georgetown University’s Center on Health Insurance Reforms.
Most states charged 150% to 200% more for premiums in their high-risk insurance program. And they often had waiting periods of 6 to 12 months before covering someone with pre-existing health conditions. Plans included annual and lifetime limits on coverage, and deductibles were very high. Most state programs had to limit enrollment to control costs.
They lost money anyhow -- more than $1 billion annually for the 35 state-based programs combined. The high-risk program run by the federal government lost more than $2 billion before closing shop. If new high-risk pools stand any chance at success, Blumberg says, they’re going to need a lot of funding.
“If you take sick people and separate them off from healthy people and give them meaningful coverage, it will cost a boatload of government dollars to do it.”
Selling Insurance Across State Lines
Historically, state governments have regulated insurance companies. Firms that wish to do business must get a license and follow that state’s specific rules. Before the Affordable Care Act became law, there was quite a bit of variation in those rules from one state to another. The law helped to make those rules more uniform.
Trump has proposed loosening existing federal requirements to make it easier for health plans to sell insurance without having to comply with the specific rules of each state in which they choose to do business.
Pros: Allowing insurance companies to sell health care plans across state lines would increase competition among insurers and do away with requirements that drive up costs. Consumers are also likely to have more choice in the variety of insurance products than they do now under the Affordable Care Act.
“You get rid of the lines, it brings in competition. So, instead of having one insurance company taking care of New York, or Texas, you'll have many,” Trump said in February during the CNN-Telemundo Republican debate.