(Bloomberg Politics) — A dilemma facing Republican presidential candidates who want to repeal the Patient Protection and Affordable Care Act (PPACA) is how to care for people with preexisting conditions. While polls show that the law isn’t popular, Americans also don’t want to return to an era where they can be denied coverage due to an illness.
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The solution, according to many Republican presidential candidates, is high-risk pools. To cover the most needy people who would be locked out of the insurance market, they propose sending money to the states.
But there’s a major problem with this idea: Republicans in Congress have refused to spend even a fraction of the money that conservative experts say is necessary to make the plan work. In fact, a 2013 attempt by House Republican leaders to fund high-risk pools went down in flames.
Wisconsin Gov. Scott Walker rolled out his PPACA alternative Tuesday. It would “provide funds to states to help provide coverage to those with pre-existing medical conditions” through high-risk pools. In an op-ed Monday, Florida Sen. Rubio reiterated his support for “federally-supported, actuarially-sound and state-based high risk pools.” The idea has also been embraced by Louisiana Gov. Bobby Jindal and Carly Fiorina.
“It’s not a new thing,” said Douglas Holtz-Eakin, a conservative policy expert who runs American Action Forum. “It takes money, more than anything else. This is a way to subsidize very expensive people.”
A 2010 paper by conservative health-policy experts James Capretta and Tom Miller in National Affairs estimated that it would cost $15 to $20 billion per year for a “comprehensive set of high-risk pool programs” aimed at covering between 2 and 4 million people. Five years later, Miller calls that a “high-end estimate,” while Holtz-Eakin says it “sounds about right.”
That adds up to $150 billion or more over a decade—hardly chump change.
In 2013, then-House Majority Leader Eric Cantor attempted to pass a bill that stripped $3.6 billion from a wellness fund in PPACA to instead spend on high-risk pools. Cantor canceled the vote at the last minute in the face of strong opposition from conservative lawmakers. At the time, his office promised to bring up the bill again, but that never happened.