After acknowledging that Zombie Trumpcare — a.k.a. some revised version of the American Health Care Act, the GOP plan to repeal and partially replace Obamacare — was not going to command enough Republican support to lurch to the House floor before the two-week Easter recess, House Republicans nonetheless scheduled a Rules Committee meeting Thursday to tweak the dead-again legislation. According to multiple accounts, the tweak involves letting two House Freedom Caucus members add language either allowing or directing states to use the $100-billion-plus slush fund designed in the earlier bill to pay off states that didn’t expand Medicaid to set up and pay for so-called “high-risk pools” for people with preexisting health conditions.
What’s up with this?
It’s hard to tell for sure. Apparently the impetus for this move came from the White House, and perhaps from the vice-president, who headed up the failed effort this week to reach agreement on a plan that could attract both HFC members who thought AHCA was too generous to old and sick people, and “moderates” who quailed at the number of people who would lose insurance. All anyone will say semi-publicly is that the administration wants to show that the effort still has a faint pulse, as noted by Bloomberg Politics:
Efforts by the Rules Committee to suddenly unveil and rush to adopt an amendment to a bill – without time for anyone to read it or any immediate intent to take the measure to the House floor – is highly unusual. But it reflects the strong desire by the White House to demonstrate that the effort to repeal Obamacare isn’t dead, despite the embarrassing setback last week when Republican leaders had to pull the bill from the House floor right before a scheduled vote.
From the point of view of health-care policy, the addition of high-risk pools nominally answers the charge that hard-core conservatives just want to ignore people with preexisting conditions. “High-risk pools” are special, government-subsidized group-insurance plans for individuals that private insurance companies decline to cover because their care is too costly. Using them is an alternative to simply requiring that insurers cover such people at nondiscriminatory prices, as the Affordable Care Act did. Removing or radically modifying that ACA provision on preexisting conditions is a chief HFC demand. So in effect the White House was helping the Freedom Caucus show a little compassion before going home for Easter, while offering a theoretical point of agreement on the key question of how to deal with those pesky sick people who are making insurance so expensive for everybody else.
It’s even possible high-risk pools are being formally added to the bill to facilitate a new CBO “score” for Zombie Trumpcare that might look a little better by offering some kind of insurance to people the bill would otherwise kick off the Medicaid rolls or the Obamacare exchanges.
Anyway you slice it, though, high-risk pools are not some sort of brilliant new answer to the GOP’s problems with health-care policy. Many states had such pools prior to the Affordable Care Act, and they typically offered really bad insurance at a horrific cost. Throwing new federal money at such pools might make the insurance less bad or somewhat more affordable. But the bottom line is that sequestering people with the most serious health needs in their own little insurance ghetto is a deceptive and cowardly way to avoid the central function of health insurance, which is to spread, not concentrate, risks. The main shortcoming of the Affordable Care Act is that it did not successfully convince enough younger and healthier people to sign up for health insurance in order to create the broadest possible risk pools. This “new” Republican idea moves in the opposite direction. Maybe it would be better for medically needy people than nothing at all, but it’s a question of degree. And so no one should get too enthusiastic about the HFC’s newfound interest in sick people, or the utility of high-risk pools as a way to bridge the gap between Republicans who do and don’t want to deal with the central problem of “market-based” approaches to health coverage — namely, that they leave many millions of people behind.