Healthcare experts are panning the change to the House’s ObamaCare repeal-and-replace bill on coverage for pre-existing conditions, saying it would not make much of a difference.
The amendment from Rep. Fred Upton (R-Mich.) would add $8 billion over five years to help people with pre-existing conditions in states that elect to waive certain ObamaCare protections.
But many experts say that this amount of money is nowhere near enough to help people with health conditions afford coverage if ObamaCare protections are waived.
“The amendment at hand focuses on high-risk pools, but the $8 billion amount is a pittance,” said Robert Graboyes, a healthcare expert at the conservative Mercatus Center. “Spread over five years, it’s a fifth of a pittance.”
{mosads}The GOP bill would allow states to waive an ObamaCare protection known as community rating, which requires insurers to cover people within a certain geographic region at similar rates. If that were repealed, insurers could go back to charging people with pre-existing conditions exorbitant premiums that could put coverage out of reach.
Supporters of the House bill say the high-risk pools would help sick people afford coverage and note that people who do not have gaps in coverage would still be protected.
Karen Pollitz, a healthcare expert at the Kaiser Family Foundation, said that the additional $8 billion would likely not be enough to make the high-risk pools workable.
She said that would be enough money to cover the costs for about 225,000 people, which is only 1 percent of the individual market.
“So for $8 billion over five [years] to be enough, almost no states would elect the waiver and almost no individuals would be rated up for their preexisting conditions,” she said.
Experts were quick to add that how far the $8 billion would go would depend on how many states choose to waive the ObamaCare protection. If few states chose to go that path, the money would go further.
But some experts warn there would be pressure on states to apply for the waiver and go back to the pre-ObamaCare rules once the healthcare law’s individual mandate and subsidies are abolished under the bill.
If the House held a vote on the healthcare bill this week, there would not be time for a Congressional Budget Office analysis of the measure, which could help shed light on the effects of the new money for the high-risk pools.
The underlying GOP bill already provides $130 billion over 10 years in funding aimed at helping sick people afford coverage through high-risk pools and other mechanisms.
The liberal Center for American Progress (CAP) found in a study this week that the amount underfunded the pools by $200 billion over 10 years.
The additional $8 billion only makes up 4 percent of that difference, noted Topher Spiro, vice president for health policy at CAP.