Solving the 'Pre-Existing Condition' Problem

Most Americans agree that no one should go bankrupt because of a chronic disease or a pre-existing condition like, multiple sclerosis or breast cancer.  Yet, millions of Americans suffer everyday from these and other chronic illnesses, and fall further and further in debt because they can’t get health insurance.  So why can’t Congress work to fix this problem?  The short answer: Washington Democrats are fixated on government-run health care, not tangible solutions to fix discrete problems in our health care system.

Is there a real, achievable solution to this growing and ever-present problem?  Indeed.  And it’s accomplished by the creation of high-risk pools for those with pre-existing conditions. 

So what exactly are high-risk pools?  For individuals that are denied insurance coverage or charged high premiums, these state-based pools provide an affordable option for health coverage.  Those with a pre-existing condition can enroll in a pool and obtain private coverage at much lower rates. 

The cost of coverage is offset, for example, by state general revenue, assessments on insurance companies, tobacco taxes, and other sources.  In essence, the healthy help pay the cost of covering those with pre-existing conditions. 

These pools also have broad bi-partisan support.  In 2005, I introduced legislation in the House with New York Democrat Edolphus Towns to provide federal grants to complement state funding for the creation and operation of high-risk pools.  The bill received unanimous support in both the House and Senate, and was signed into law by the President in 2006.  

Yet, during the President’s health care summit, he and Washington’s top Democrats either willfully distorted the truth, or have no understanding of how these pools actually work.

Here’s an alarming example.  At the summit, the President and his Administration discounted the merits of the Republican proposal to address pre-existing conditions through an expansion of high-risk pools.  HHS Secretary Kathleen Sebelius said: “when you put all the sick people together and you say, okay, you get to buy a policy and you get no help with that policy, it is a death spiral.”

President Obama continued the spread of misinformation, saying: “if you set up a high-risk pool in which you don’t have healthy people, younger people in the same pool as older, sicker people, the premiums for the older, sicker people, who have been segregated into this pool, is just going to be higher.”

The White House’s description is flat wrong.  That’s not how any high-risk pool works.  In reality, the cost of coverage for the sick is offset by both state and federal revenue.  No state-based high-risk pool anywhere in America is structured to simply segregate sick Americans into a pool to fend for themselves.  Although Congress has certainly pushed its fair share of bad ideas, why would a strong bipartisan coalition vote to support a high-risk pool system like the one described by President Obama and Secretary Sebelius?

It is stunning that at this late date, there is such lack of understanding from the White House on how high-risk pools can be used to provide reasonably priced coverage to those with pre-existing conditions.  And it serves as evidence that Washington Democrats are using the issue of pre-existing conditions to sell their 2,700-page bill filled with spending, mandates, rules, and regulations instead of carefully considering bipartisan solutions such as high-risk pools.

Today, approximately 35 states across the county have some variation of high-risk pools for their citizens.  Along with my fellow Republicans, I have proposed expanding funding for high-risk pools to eliminate waiting lines, lower premiums, and expand these pools to all 50 states.  States should also have the flexibility to use these funds for reinsurance and other risk-adjustment mechanisms to assist Americans who have been priced-out of the insurance market. 

What’s the alternative?  Democrats’ plans say insurance companies can no longer deny coverage for pre-existing conditions.  Yet, they conveniently gloss over the fact that this will only work if federal bureaucrats force Americans to buy government-approved coverage.  Their plan, loaded with new federal mandates, will undoubtedly raise the cost of health coverage for Americans

Creating high-risk pools will help millions of Americans access affordable coverage.  Coupled with across-state purchasing and tax equity for those without employer-based insurance, we could end the problems associated with pre-existing conditions and give Americans full control of their health care.  Democrats can achieve real health care reform if they scrap their bill and start working with Republicans today.