By Sam Baker - 04/17/13 11:52 PM EDT
House Republicans are trying to pump $4 billion into an ObamaCare program.
The Energy and Commerce Committee passed a bill Wednesday to beef up funding for the healthcare law’s high-risk insurance pools, which have stopped accepting new patients due to a lack of funding.
The additional money for high-risk pools would come out of another part of the healthcare law — its fund for prevention and public health, which Republicans decry as a "slush fund."
Some Republicans were clearly prepared for criticism.
“A minority of our conference feels that the only vote that should be taken against ObamaCare is a repeal vote — all or nothing, to kill it dead,” Rep. Phil Gingrey (R-Ga.) said. “I’ve always felt that ... if we see areas we can chip away at, that are the most egregious parts of the bill, we really should do that.”
Republicans have a lot riding on the performance of the high-risk pools.
While the program is a relatively small piece of the Affordable Care Act, high-risk pools make up the cornerstone of Republican plans to “repeal and replace” the law.
House Republicans have said high-risk pools should replace one of the healthcare law’s most popular provisions — the requirement that insurance companies cover people with pre-existing conditions.
If the high-risk pools in the Affordable Care Act prove ineffective, Republicans could have a harder time making the argument that they could help make up a viable alternative to ObamaCare.
Rep. Henry Waxman (D-Calif.) said it’s “ironic” that Republicans are trying to spend more money on a government-run healthcare system, while the Democrats’ healthcare law covers the uninsured through the private market.
“People ought to be able to buy insurance,” Waxman said. “And people with pre-existing conditions are higher-risk and would be charged a higher price if we didn’t spread out the population to get as many people as possible covered.”
Under a high-risk pool, the government pays to insure sick people who have been denied coverage because of a pre-existing condition. The pools contain only the sickest and most expensive patients, and the government is left with the bill.
Under the Affordable Care Act, insurers lose the right to deny people coverage because of pre-existing conditions and the cost of covering sick people is spread across the entire healthcare system. The law established temporary high-risk pools as a bridge until the ban on coverage denials takes effect on Jan. 1, 2014.
Supporters of the healthcare law concede that the high-risk pools have had their share of problems, but they say the program’s difficulties prove that the Affordable Care Act is better than what the GOP is proposing.
“It really does confirm that they are not a long-term solution to covering large numbers of people,” said Sara Collins, vice president for affordable health insurance at the Commonwealth Fund.
The temporary program has served its purpose, Collins said, as well as highlighted the high cost of using high-risk pools as a long-term solution.
“It’s just not an efficient way to cover a large number of people,” she said. “By design, a high-risk pool is going to run into the difficulties that this one did.”
When the healthcare law’s high-risk pools first launched, premiums were so high that even some sick uninsured people wouldn’t apply, and enrollment fell significantly below initial projections.
The administration took steps to loosen the requirements for enrollment in 2011, which helped lower premiums. But the program’s costs remained high enough that the administration cut off new enrollees in February, to ensure that the program’s $5 billion budget would stretch until 2014 for the people already enrolled.
Rep. Michael Burgess (R-Texas) said the high-risk pools were underfunded to begin with. Providing just $5 billion “was never really a serious effort,” he said.
Burgess hammered President Obama for cutting off new enrollment in the program, saying it leaves the uninsured without options until next year.
“ ‘Now that we got it passed, we don’t care about you any more. You were a political pawn,’ is what the president is telling people with pre-existing conditions,” Burgess said.
He said it’s also important for Republicans to make the case for purely state-run high-risk pools, arguing that ObamaCare introduced too much federal overlap. It’s not that high-risk pools are a bad idea, Burgess said, but that they need to be structured differently.
“If it was done correctly, it would have been an effort by the federal government to help those states that were doing this,” he said.
Republicans are willing to send extra money into the flawed system because they want to help the uninsured, even though they’re still opposed to ObamaCare, Burgess said.
“If the goal were met, it would be: You don’t throw anyone under the bus; at the same time, you work toward getting the policy that would be superior,” he said.