The Republican solution to sick people who need health insurance in a post-Obamacare world is increasingly coming to center on three words: high-risk pools.
The White House has reportedly secured the support of Rep. Fred Upton (R-MI), a longtime legislator, by promising an additional $8 billion to fund these programs. That would mean the Republican plan has nearly $115 billion that states could use, if they wanted to, for high-risk pools.
…There were 35 state high-risk pools before the Affordable Care Act passed. To control costs, they would often do things like charge higher premiums than the individual market. Most had waiting periods before they would pay claims on members’ preexisting conditions, meaning a cancer patient would need to pay premiums for six months or a year before the high-risk pool would cover her chemotherapy treatments.
Kliff then notes those pools have proved quite expensive. And:
The Republican bill doesn’t require states to build high-risk pools — it just gives them the option. And it has little to say about how states should build them if they decide to do so. It is possible they would also have lifetime limits and preexisting condition waiting periods. Those details are hugely important, but are unlikely to get sorted out until after the bill passes and the Trump administration begins to write regulations.
I don’t favor ACHA, which I see as bringing no benefit and also as involving a cynical desire to repeal Obamacare simply to fulfill a campaign promise (and it needs a CBO score). Still, I see many people fulminating about this change toward high risk pools, yet without defending their position much beyond a hand wave. Should all requests for emergency medical care receive additional government funding? Obamacare itself does not embody anything remotely like that principle, for instance consider all the medical conditions not covered under the mandate, or covered only imperfectly. Not to mention the rare diseases that receive only limited R&D dollars. And we’re about to run out of yellow fever vaccine — nasty! The list goes on and on. How are those pandemic preparations coming?
If the federal government is asked to pick up the tab for high-risk pools or some rough equivalent, it probably visualizes the cost in terms of either additional borrowing or as a common pool problem. It is close to a free lunch in political terms, arguably even a political benefit, now that Obamacare is more popular.
If balanced-budget state governments are asked to pick up the tab, they will wonder whether that money should better be spent on schools, roads, and prisons. Many of them will be reluctant. Maybe that is right or wrong, but is “let’s have a democratically elected state government decide how much to subsidize medical care for those with preexisting conditions” such a morally outrageous view? I guess it is these days. The simple but underemphasized truth is that under the new bill state governments can spend as much as they want on high-risk pools.
(Is it not sobering to think that if the high-risk patients are put into a separate pool, and have to ask for state-level but taxpayer-sourced money in a direct and transparent manner, the political support for that funding is not so strong? That is perhaps the real lesson here. In this debate, both sides are the enemies of transparency.)
Which is the better perspective? Federal or local? The answer is obvious if you believe all requests for emergency medical care should receive additional government funding. But, as I’ve mentioned, no one believes that. I do see people who cite that principle when it is convenient in one part of a debate, and who forget about the same principle for other policy choices.
And please, don’t compare these marginal health care expenditures to “tax cuts for the rich” — instead advocate for where you most want to see the money spent! Don’t let the silly Republicans bail out your analytical apparatus once again; any program is easy to justify in your own mind if you put it up against what you consider to be a very weak alternative use of the funds. It is fine to say “bigger subsidies for high-risk pools are better than tax cuts for the rich, but they are still only my 17th most preferred use for the funds.”
Along related lines, while I favor taking in many more refugees, I also understand that any feasible migration policy involves leaving many refugees and potential migrants to their possible deaths, and with a relatively high probability in some cases. So if your moral argument is “we should let in person x, or person x will die,” you need to provide a limiting principle once again.
Most generally, beware of moral arguments that a) lower the status of some other group of people, and b) do not state and justify their limiting principles. They are ways of substituting in pleasurable moralizing in lieu of dealing with the really tough questions.
Addendum: Here are some new and relevant results cited by David Leonhardt, I haven’t had time yet to read through them.