In response to a disingenuous new ad from the Scott Walker campaign, Brad Woodhouse, executive director of Protect Our Care, issued the following statement:
“We know Scott Walker supports gutting protections for pre-existing conditions because he authorized a lawsuit that would eliminate these protections entirely. Scott Walker’s plan for health care would literally turn the clock backward by bringing back discrimination against pre-existing conditions through his lawsuit and by reviving Wisconsin’s high-risk pool, which has been panned by experts because it drives up costs and restricts coverage. In fact, in testimony before the U.S. House of Representatives, the chief medical officer of the American Cancer Society specifically criticized Wisconsin’s high risk pool for the deadly waiting periods it imposed on people who needed care when they got sick. I’ll say it again: if Scott Walker wants to show he stands up for people with pre-existing conditions, he’ll withdraw his lawsuit to take away the protections we have in current law away.”
SCOTT WALKER’S LAWSUIT WOULD REVERSE PRE-EXISTING CONDITIONS PROTECTIONS, THREATENING 2.4 MILLION WISCONSINITES’ CARE
2,435,700 Wisconsinites Live With A Pre-Existing Condition. About one in two Wisconsinites, 51 percent, lives with a pre-existing condition. [CAP, 4/5/17]
1,187,000 Wisconsin Women And Girls Have A Pre-Existing Condition. Approximately 1,187,000 women and girls in Wisconsin live with a pre-existing condition. [CAP & National Partnership For Women and Families, June 2018]
308,100 Wisconsin Children Already Have A Pre-Existing Condition. Roughly 308,000 Wisconsinites below age 18 live with a pre-existing condition. [CAP, 4/5/17]
616,900 Older Wisconsinites Live With A Pre-Existing Condition. 616,900 Wisconsin adults between the ages of 55 and 64 live with at least one pre-existing condition, meaning attacks on these protections significantly threaten Wisconsinites approaching Medicare age. [CAP, 4/5/17]
IT IS THE AFFORDABLE CARE ACT THAT OUTLAWS DISCRIMINATION BASED ON PRE-EXISTING CONDITIONS
Because Of The Affordable Care Act, Insurance Companies Can No Longer Deny Coverage Or Charge More Because Of Pre-Existing Conditions. “Under current law, health insurance companies can’t refuse to cover you or charge you more just because you have a ‘pre-existing condition’ — that is, a health problem you had before the date that new health coverage starts.” [HHS]
The ACA Outlawed Medical Underwriting, The Practice That Let Insurance Companies Charge Sick People And Women More. As the Brookings Institution summarizes, “The ACA outlawed medical underwriting, which had enabled insurance carriers to court the healthiest customers while denying coverage to people likely to need costly care. The ACA guaranteed that all applicants could buy insurance and that their premiums would not be adjusted for gender or personal characteristics other than age and smoking.”
The ACA Stopped Companies From Charging Women More Than Men For The Same Plan. The Affordable Care Act eliminated “gender rating,” meaning American women no longer have to pay an aggregated $1 billion more per year than men for the same coverage.
Thanks To The Affordable Care Act, Insurance Companies Can No Longer Rescind Coverage Because of Illness. Because of the ACA, insurance companies can no longer rescind or cancel someone’s coverage arbitrarily if they get sick.
HIGH RISK POOLS IMPOSE HIGH PREMIUMS & DEDUCTIBLES …
Premiums For Coverage In High Risk Pools Were As Much As 200 Percent Higher Than The Average Rate But Covered Less Care. “High-risk pool enrollees faced substantially higher premiums than people in the normal individual market, often by as much as 150 percent to 200 percent, although some pools did offer subsidies to low-income enrollees…And stunningly, the overwhelming majority of state high-risk pools actually refused to pay for services associated with a patient’s pre-existing conditions in the first months of their enrollment.” [Center for American Progress, 2/16/17]
Deductibles For High Risk Pool Enrollees Were Well Above Maximum Allowed By ACA. ”Fourteen states had plans with deductibles of $10,000 per year or higher, substantially greater than the current maximum $7,150 deductible for catastrophic plans in the marketplaces. Thirty states imposed maximum lifetime limits; others had annual coverage limits as low as $75,000 per year.” [Commonwealth Fund, 3/29/17]
… COST TAXPAYERS MORE …
Despite High Premiums, High Risk Pools Could Still Cost The American People Over $90 Billion Annually. “The U.S. Department of Health and Human Services (HHS) recently estimated that up to 17,875,000 people with preexisting conditions were uninsured in 2010. Had all of them been covered by high-risk pools, the cost would have been $194.8 billion in 2010 dollars, with premiums covering only $103.3 billion. Thus, states and the federal government would have needed to find $91.5 billion in additional funding to cover them all—much more than the up to $10 billion per year in federal assistance to states recently proposed by congressional Republicans.” [Commonwealth Fund, 3/29/17]
An Analysis Of High Risk Pools Under The ACHA Finds Such Pools Would Cost The Government Between $37 and $56 Billion Annually. “Government costs for supporting the high-risk pool using ACA-like coverage and subsidies would range from $37 to $56 billion in 2020 and $437 to $656 billion over 10 years (2020–2029), depending upon the eligibility rules used.” [The Urban Institute, May 2017]
Even Conservatives Estimated High Risk Pools Would Cost $15-$20 Billion Annually. “For comparison, conservative experts James Capretta and Tom Miller have estimated that $15 billion to $20 billion per year, or $150 billion to $200 billion over 10 years, would be needed to fully finance high-risk pools even if they covered only 2 million to 4 million people.” [Center For American Progress, 2/16/17]
Premiums For High Risk Pool Coverage Paid Just 53 Percent Of Program Costs. “Premiums ranged from 125 percent to 200 percent of average premiums in the individual market, yet covered only about 53 percent of claims and administrative costs nationally (Wisconsin allowed premiums up to 200 percent of average).” [Commonwealth Fund, 3/29/17]
… AND RESTRICT COVERAGE
High Risk Pools Typically Had Pre-Existing Condition Exclusions And Limited Benefits. “Many such pools had pre-existing condition exclusion periods, limited benefits, and enrollment limits; all of these characteristics served to reduce the value of the coverage, creating high financial burdens for enrollees and limiting the number of people who could access the coverage.” [Health Affairs, 3/15/16]
Most State High Risk Pools Had Lifetime And Annual Limits On Coverage. “Thirty-three pools [out of 35 states] imposed lifetime dollar limits on covered services, most ranging from $1 million to $2 million. In addition, six pools imposed annual dollar limits on all covered services while 13 others imposed annual dollar limits on specific benefits such as prescription drugs, mental health treatment, or rehabilitation.” [Kaiser Family Foundation, 2/22/17]
High Risk Pools Typically Had Waiting Periods. “There were 35 state high-risk pools before the Affordable Care Act passed. To control costs, they would often do things like charge higher premiums than the individual market. Most had waiting periods before they would pay claims on members’ pre-existing conditions, meaning a cancer patient would need to pay premiums for six months or a year before the high-risk pool would cover her chemotherapy treatments.” [Vox, 5/3/17]
High Risk Pools Mean Delayed Or Forgone Care. “Even once they were in a high-risk pool, the high costs and limited benefits prompted some people to delay or forgo care, leading to poorer health outcomes and even more spending. And many families accrued substantial medical debt, even with the coverage.” [Stateline, 2/16/17]
HIGH RISK POOL = MORE PEOPLE UNINSURED
Limited Coverage And High Costs Cause People To Remain Uninsured. “Some patients also delayed care to save money, exacerbating their health conditions, and only entered the pools when their conditions became emergencies.” [Stateline, 2/16/17]
CMS: One-Third Of Uninsurable Were Unable To Afford High Risk Pool Coverage. A 2004-05 study by the Center for Medicare and Medicaid Services found that “nationally, high-risk pool premiums are above 25 percent of family income (i.e., are unaffordable) for 10 percent of all individuals, 18 percent of the uninsured, and 29 percent of the uninsurable. By these standards, almost one-third of the uninsurable are unable to afford high-risk pool coverage…” [CMS, Health Care Financing Review, Winter 2004-2005]
HIGH RISK POOLS HAVE BEEN TRIED & FAILED
In Wisconsin, “Cancer Doesn’t Wait” For High Risk Pool Waiting Periods. “The benefit waiting periods used by Wisconsin’s and other states’ high-risk pools are a big concern for patient advocates and provider groups. ‘A six-month exclusionary period is a serious issue,’ said Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society, who also testified at the House hearing. ‘Cancer doesn’t wait.’” [Modern Healthcare, 2/13/17]
California High Risk Pool Led To Waiting Lists, High Premiums, And Lifetime Limits. “For example, California’s high-risk pool imposed a shorter-than-average, three-month waiting period before enrollees could receive treatment for pre-existing conditions—but also imposed a $75,000 annual limit on benefits along with a $750,000 lifetime limit. In addition, the state capped enrollment, resulting in long waiting lists of people unable to enroll; at the same time, the pool’s high premiums proved difficult for enrollees to afford, leading some to drop out.” [Center for American Progress, 2/16/17]
Premiums in Florida’s High Risk Pool Were Twice The Normal Rate. “Many states starved high-risk pools of cash. Florida’s contained only about 200 people in 2011. Premiums were commonly twice the normal rate. Many states had enrollment caps, meaning that even people willing to fork over were not guaranteed coverage.” [The Economist, 1/16/17]
In Utah, High Risk Pools Were Limited In Size, And Offered Sub-Par, Delayed Coverage. “Stevenson said only 3,000 people signed up for Utah’s risk pool plan while 200,000 Utahns are signed up for insurance through Obamacare. ‘Utah’s past high risk pool plan had many limitations too,’ he said. People with pre-existing conditions had to wait six months before using their coverage. Pregnant women had a 10 month waiting period before they had any coverage for them or their baby. ‘The measure of success for a program is how many people it helps and if you are only covering 3,000 people and leaving tens of thousands uninsured, I don’t think that’s a good thing to go back to,’ he said.” [CBS KUTV, 3/9/17]
High Risk Pools Mean Higher Costs, Higher Uninsured, And Less Coverage. “The reality is that high-risk pool coverage was prohibitively expensive and there is little evidence to suggest that the existence of such pools made coverage less costly for others in the individual insurance market. Without substantially more federal funding than currently proposed, these facts are not likely to change. People with preexisting conditions may have “access” to coverage, but most will not be able to afford it and those who can will face limited benefits and extremely high deductibles and out-of-pocket payments.” [Commonwealth Fund, 3/29/17]
