Upton Amendment Enters the Health Care Fray – Vote Iminent

So now we have added the Upton thing to the health care bill in order to deal with the formerly weak provisions regarding Americans who have medical conditions and need to get health insurance.

This is based on the idea of a high risk pool which Maine pioneered in health care.

Bangor Daily News (which hates Trump):

Here’s how Maine’s program worked. Insurers tried to predict which of these individuals would be the riskiest for them to cover. In other words, who would cost them the most, based on a medical questionnaire? If you had certain diagnoses, such as kidney failure or various cancers, the insurer would still cover you, but you’d be lumped into the high-risk pool. Consumers never had any idea that they’d been selected for this little club, which is why this kind of arrangement is referred to as “invisible risk sharing.”

Behind the scenes, the insurer agreed to pay a small portion of your claim costs, and forked over 90 percent of the premiums you paid to help fund the pool. Along with that, everyone else with private health insurance helped to pay for your medical claims, through a fee of $4 every month. That added another $21 million into the system to subsidize the medical care of those in the high-risk pool.

The pool was run by a nonprofit board called the Maine Guaranteed Access Reinsurance Association, created under a Republican health reform law known as Public Law 90.

Proponents claim it slashed premiums. “Maine policymakers were able to cut premiums in half while still guaranteeing those with pre-existing conditions access to plans,” conservatives who helped pass the law recently wrote in the Health Affairs blog.

Unlike “traditional” high-risk pools, Maine’s allowed people with pre-existing conditions to shop for the same insurance plans as everyone else and didn’t charge them higher premiums, they wrote.

The success of the law, proponents say, was also due to the fact that Maine began allowing insurers more flexibility to charge rates based on age. Before, insurers could charge an older person only up to 1.5 times more than a younger individual, but PL 90 allowed them to charge up to three times more. That encouraged insurers to offer cheaper policies to young and healthy consumers, whose premiums then helped to offset the costs of older, sicker policyholders, they said.

The law also allowed insurers to adjust their rates based on where policyholders lived.

Anthem, the largest insurer in that market at the time, sought to increase rates by 1.7 percent. Without the program, the company would have jacked up premiums by more than 20 percent, it told the state insurance bureau in 2013.

Skeptics say it’s not that simple. Under the law, insurers could vary rates depending on age only for new policies, not for existing customers who decided to keep their plan. So older, sicker customers predictably hung onto their existing plans with lower premiums, while younger ones who benefited under the law opted for new policies, health policy experts Nicholas Bagley and Mark Hall countered in another Health Affairs blog post.

At the same time, coverage got a lot skimpier, they wrote. A new policy, for example, doubled the amount of out-of-pocket costs consumers had to pay and dropped maternity coverage entirely.


NOTE – FACT- Under the present law, older Americans pay THREE TIMES the basic premium ANYWAY, then geographical considerations further affect that.

High risk pools DO WORK. The problem is that by pushing this to the state level then funding it in federal grants to the state, how does this not make it harder to engage the main engine of competitive pressures to lower premiums… national competition among all insurers? Every state will have different policies by their own regulatory agencies and insurance commissioners (where the real power is). How does all that get untied? A federal law superseding and nullifying every state’s internal health insurance structure? Some states might waive the entire pre-existing clauses.

This just makes things MORE complicated, but deals with pre-existing conditions (provided the grants match the costs). Once again, are we still dependent on an invisible and equally impossible to pass phase 2 and 3 to get to where the real power to lower premiums reside?

This is 16-20% of an economy we are trying to get from 1% GDP growth to 4% OR THE DEBT GROWS EVERY YEAR until finally the largest item in the budget is debt service, and there is nothing for anyone

PS ..Congress, the Senate, the rest will STILL have separate and superior medical system.


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