Tom Zehner: National health care plan is solution | SteamboatToday.com

Tom Zehner: National health care plan is solution







No, it's not a swimming pool with two deep ends. The term "high risk pool" refers to a separate plan where insurance companies jointly group the additional costs to cover poor risk individuals who have been refused coverage under standard policies.

Putting someone into a high risk pool is up to insurance companies. Do you know how easy it is to end up in a high risk pool?

If your records indicate even temporary depression, pre-cancer anything, intestinal polyps, suspicious pap smears, suspicious PSA tests, and so on, could place you in a high risk pool. This could happen to any of us at any time.

The idea behind the Affordable Care Act (Obamacare) is to put one and all, old, young, sick and healthy into the same insurance pool. In this way the healthier, less expensive people subsidize the cost of care for the less healthy, more expensive ones through their insurance premiums.

For this to work, the ACA health care law requires that everyone purchase health insurance, the so-called individual mandate. This provides reasonable coverage for people in poor health but a relatively more expensive insurance premium for the healthy.

The GOP (Trumpcare) version would place the healthier, less expensive people into one pool and place the less healthy and more costly people into a high risk pool. The high risk pool individuals would have to pay a lot more for their insurance. In order for average individuals to afford the high risk pool insurance they would need to have their premiums subsidized.

There are 35 states that, before the ACA, developed high risk pools for their insurance premiums. Many states had to charge high deductibles and cap annual and lifetime payments, or, exclude individuals with pre-existing conditions. In order to cover this high cost, insurance companies received subsidies from the state and federal government.

By concentrating risk, high risk pools also concentrate costs, which ends up generating greater expenses to consumers and administrators. This drives insurance plans to impose severe coverage limits that often serve to negate the benefit of having insurance.

On a state level, the high risk pools proved to be costly and expenditures were difficult to forecast. On a federal level, to cover the substantial high risk population with preexisting conditions would be extremely expensive and, more than likely, unsustainable.

Most of the Republican proposals to roll back the ACA depend on federal support for states' high risk pools in the form of grants or a state partnership similar to Medicaid. Instead of subsidizing the most expensive patients through their premiums, Americans would bear the costs through their taxes.

Risk pooling will determine who pays the costs and how but not the size of the total bill. The concern is that whatever funding mechanism Trump and Congressional Republicans come up with may be insufficient. Thus, the real elephant in the room is finding a solution to address the problems that high risk pools have experienced in the past.

So what is the solution? Well, the ACA can be improved; Trumpcare may work if properly funded. But, Republicans did not provide a viable health care plan to vote on after working on it for seven or more years.

I think the real solution is a national health care plan that includes everyone. The only way we can achieve this goal is to elect and support bipartisan Congressional leaders who want to solve the problem.

Tom Zehner

Steamboat Springs