State Officials Call for Return to Pre-Obamacare High-Risk Pools

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By Sara Hansard

Sept. 15 — States should be able to return to using high-risk pools to cover people who have medical problems, state insurance regulators told a Senate committee Sept. 15.

Given the flexibility to adopt their own programs, “We would probably to a large part go back to [the] high-risk pool that we had in the past,” which provided good medical care for people with medical conditions at a reasonable cost, Wisconsin Deputy Insurance Commissioner J.P. Wieske told the Senate Homeland Security and Governmental Affairs Committee.

Insurance regulators from Iowa and Ohio also said the high-risk pools that operated in their states before the Affordable Care Act were an effective way of covering people with medical problems, which was a major goal of the 2010 health-care law.

The testimony of the three state regulators—who were called to testify by the committee's Republican majority—represented a push to return to the high-risk pools that were in effect in 35 states before they were shut down under the ACA. The idea has been floated by House Speaker Paul Ryan (R-Wis.) in his plan to replace the ACA, and has been criticized by Democrats and ACA supporters as being too expensive and providing inadequate coverage.

States Want Flexibility

Regulators from four states, including Democrat Mike Kreidler of Washington, echoed the refrain that states should be given flexibility to come up with ways to reduce high premium increases and shrinking plan choices that are expected to take place in the ACA marketplaces in 2017.

Holding down cost increases in prescription drugs is important to help stabilize the health insurance market, Kreidler said. Prescription drug cost increases were “the No. 1 driver” of 2017 premium increase requests averaging 13.5 percent among the 13 health insurers selling plans in Washington's ACA individual market, he said.

Kreidler also said the 19 states that haven't expanded Medicaid under the ACA should do so, and so-called grandmother plans that don't conform with the ACA that were allowed to stay in effect until the end of 2017 should come into compliance. “You have a break-up of the risk pool by virtue of non-conforming plans,” he said.

Kreidler also called for more standardization of plans, and he said narrow networks employed by many marketplace plans can be a good way to hold down premium costs if they provide high-value, coordinated care.

Ohio's Options Have Decreased

Ohio Lt. Gov. Mary Taylor (R), who is also the director of the Ohio Department of Insurance, testified that average premiums in Ohio's federally facilitated marketplace have gone up 91 percent since 2013, the year before the ACA marketplaces were implemented.

Prior to implementing the ACA, more than 60 companies sold health insurance products with a wide variety of options and premiums in Ohio, Taylor said. Indications are that in 2017, only 11 companies will offer marketplace products on the federally facilitated marketplace in Ohio, and 47 counties will likely have just one or two insurers, compared with at least four insurers offering products in all 88 counties in 2016, she said.

Ohio has fewer than 250,000 people in its ACA marketplace out of its population of 11.6 million people living the state, Taylor said.

“We have completely upended the health insurance market, forced consumers to buy coverage they don't want or need, placed significantly regulatory burdens on job creators, all to offer taxpayer-backed insurance to 2.15 percent of our population,” she said.

“We need to increase access by reducing costs, instead of forcing everyone to buy the more expensive coverage that in many cases they don't need and they don't want,” Taylor said.

Iowa Will Consider ACA Waiver

Iowa's Insurance Division commissioner, Nick Gerhart, encouraged Congress “to look at this idea of high-risk pools, and maybe push it back to the states.”

Iowa will look at the possibility of asking for a waiver under Section 1332 of the ACA, Gerhart said. Under that section of the law, states can make broad changes to the ACA as long as the coverage is at least as comprehensive and affordable as would be provided absent the waiver, provides coverage to a comparable number of residents of the state, and doesn't increase the federal deficit (23 HCPR 1841, 12/21/15).

Gerhart also said the ACA's temporary reinsurance program to cover high-cost enrollees, which ends after 2016, “actually works pretty well. It did help stabilize the market a little bit.” The program has paid ACA insurers $15.6 billion for 2014 and 2015.

To contact the reporter on this story: Sara Hansard in Washington at

To contact the editor responsible for this story: Kendra Casey Plank at

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More information on the hearing is at

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