Dive Brief:
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In faint hope of resurrecting the American Health Care Plan that stalled two weeks ago, Republicans on Capitol Hill want to add $15 billion to the bill to help insurers pay for its sickest members.
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Supporters of adding $15 billion for invisible high-risk pools said the program would lower premiums because the most costly individual insurance members would go into the high-risk pools and the government would help pay for those patients' care. Proponents said moving costly people into high-risk pools will cause insurance market premiums to fall.
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Milliman Inc., released a 27-page assessment of the proposal, which said the plan would cost well more than the $15 billion price tag. Plus, the plan would create government-set rates to hospitals, doctors, and other health providers for the sickest members in individual health insurance plans.
Dive Insight:
The amendment doesn't really change expectations for the bill. Congress now heads for a two-week spring break and even supporters of the high-risk pools believe the GOP doesn't have the votes to pass the law even with a high-risk pool amendment.
The Republican plan would put people with high healthcare costs, such as cancer and AIDS patients, into a separate high-risk pool. The $15 billion from the federal government would help insurers pay for the high-risk individual insurance members over nine years. Supporters say that moving high-risk members out of the general member pool will reduce premiums for other members and could open up less costly plans to uninsured people.
Members of the House Freedom Congress, which is made up of conservative Congressmen that helped derail the healthcare reform bill two weeks ago, proposed adding the high-risk pools to the bill.
Proponents say high-risk pools will stabilize the insurance market, but opponents say high-risk pools don’t cut costs and will lower payments to hospitals and doctors.
In its report, Milliman Inc., said the invisible high-risk pools would not lower premiums, but could reduce the uninsured by 1 million or 2 million if the program is successful. That 1 to 2 million newly insured is still far less than the 24 million uninsured that the Congressional Budget Office predicted if the bill passes.
The amendment comes at a time of upheaval and doubts in the individual insurance market. Aetna and Wellmark Blue Cross and Blue Shield both said recently that they are pulling out of the Affordable Care Act plan market in 2018 in Iowa because of costs and an unclear future. That means one insurer, Medica, will be the only option in the ACA exchange for 94 counties in Iowa.