Republican Health Plans Have Winners And Losers, Just Like Obamacare | FiveThirtyEight

"The Affordable Care Act sacrificed affordability in order to get more people insured. Prohibiting companies from denying people insurance because of pre-existing conditions, for example, opened up access to everyone, but it also made insurance more expensive for people who were healthy. Similarly, requiring insurers to offer a comprehensive set of benefits meant that low-cost plans offering only catastrophic coverage were no longer allowed for most people, which meant higher premiums for everyone. President Trump has promised to insure more people at a lower price, but it’s not clear how he could make that happen.



Now, Republicans who have promised for years to repeal and replace the ACA are tasked with balancing winners and losers, coverage and cost. GOP House members outlined their replacement plan last week. Here’s a look at how the main policy proposals would shake out against the current system.



Insuring the sickest Americans



Underlying the tradeoffs of any health policy is the world’s most expensive medical system. Until we do something about the high cost of care overall, someone has to pay, whether it’s the federal government with tax dollars, companies or individuals. But just a sliver of the population is responsible for the majority of health care spending in the U.S., and figuring out how to pay for the most costly patients is one of the biggest challenges in health care policy.



Before the ACA, many states had high-risk pools: state-run programs for people with serious medical needs who couldn’t get health insurance elsewhere. Most enrollees had been turned down for coverage by insurance companies because of pre-existing health conditions and didn’t have an employer-sponsored plan. In 2007, 34 states had pools that spent more than $1.8 billion on the 201,000 people enrolled in these programs, which did little to reduce the overall uninsured rate but were life changing for many of the people they did cover.



By requiring that insurers cover everyone, including those with pre-existing conditions, the ACA did away with those programs. Republicans have pushed to bring this system back, because removing the people who cost the most to treat would result in lower premiums for everyone else in the general insurance pool. That shift would isolate the people with the greatest medical needs, however, and leave them open to funding shortfalls. The programs rely on sick people paying more for care, anywhere from about 120 percent to 250 percent of what a healthier counterpart would pay, which can be an added strain on families. In Minnesota, which had the oldest and largest high-risk pool in the country, a 60-year-old man in the program paid $685 per month for a plan with a $2,000 deductible in 2014, according to information gathered by Lynn Blewett, a professor at the University of Minnesota who has studied high-risk pools. “For people who could afford it, it was a good product,” Blewett said. “But there were a lot of people who couldn’t afford it.”



Republican Health Plans Have Winners And Losers, Just Like Obamacare | FiveThirtyEight