WHA points to high-risk pools as option for stabilization

The Wisconsin Hospital Association said today that one option as the Trump administration looks to stabilize individual health care marketplaces is turning to the high-risk pools that the Affordable Care Act eliminated.

But WHA warned that “the details really matter” in how the high-risk pools for those with the costliest health conditions are set up.

WHA says neither the House or Senate Republican bills to replace the Affordable Care Act put enough money toward establishing sustainable high-risk pools. If those pools are set up, the group says, they should be funded adequately and states should have flexibility to set up programs that meet their local needs.

WHA submitted comments to the feds yesterday on what they should do to stabilize the health care individual marketplace. The group says the high-risk pool in Wisconsin that went away due to the Affordable Care Act was effective, partly because the board overseeing it had representatives from insurance companies, health care providers and patients.

“What we know from Wisconsin’s experience is that if adequately resourced and properly focused and structured, risk pools can help address some of the instability now threatening the individual market,” WHA President and CEO Eric Borgerding said in a news release. “But saying and doing are two different things when it comes to sustaining high risk pools; the details really matter here.”

The group also called on the Trump administration to fund a set of subsidies for Healthcare.gov consumers that bring down the costs of deductibles and copays. Trump has weighed eliminating the funding for those subsidies, which WHA wrote would mean insurers “would likely have to choose between exiting the markets or significantly increasing premiums to cover the unfunded mandate.”

And it called on the feds to give Wisconsin funding for the approach it took to expand Medicaid.

Gov. Scott Walker turned down the Medicaid expansion for people slightly above the poverty level that the ACA called for, along with hundreds of millions of dollars from the feds. Instead, he chose a partial expansion that ensured everyone under poverty could get Medicaid coverage.

WHA said in its comments that Wisconsin “has been a model in avoiding gaps in coverage” through the model it chose but that the Obama administration declined to give the state additional funding for those efforts.

WHA wrote that CMS should give Wisconsin funding to reward that expansion and let other states take a similar approach.

See the WHA release:

See the comments WHA submitted:

–By Polo Rocha