As my colleague Chuck Blahous noted this week, you can lay the financial burden of pre-existing conditions on four different groups: sick patients themselves, young and healthy insurance enrollees, taxpayers, or some amorphous deep pockets to be named later. Almost no one wants the burden to fall on sick patients. The Affordable Care Act asks young and healthy insurance enrollees to pay, but fails to entice enough of them to do so. Many on the Left want to bill federal taxpayers via a single-payer system; many on the Right want to bill state taxpayers via high-risk pools. Loads of people mumble about “rich people” or “insurers” or some such to pay, but rhetoric far exceeds reality.
No matter which scheme is adopted, a large percentage of the American public has to shell out an enormous amount to make it happen. And by and large, healthy insurance enrollees are also federal and state taxpayers—so the argument is mostly over which pocket the money comes out of. The amendment at hand focuses on high-risk pools, but the $8 billion amount is a pittance. Spread over five years, it’s a fifth of a pittance. Yes, the GOP’s American Health Care Act includes additional money for high-risk pools, but still far less than the pre-existing problem demands. High-risk pools have traditionally been underfunded. That doesn’t seem to be changing.