The Affordable Care Act put an end to insurance companies charging higher health insurance premiums to people for having a pre-existing condition.
But the Republican replacement for Obamacare would make that practice possible again.
GOP House Speaker Paul Ryan says not to worry, just look at how his home state of Wisconsin took care of people with pre-existing conditions before Obamacare.
So let’s see what case he's making.
On May 7, 2017, three days after the House of Representatives narrowly approved the Obamacare replacement, Ryan appeared on ABC’s "This Week." He said that under the bill, labeled "Trumpcare" by some Democrats, states could ask for a waiver from the federal government that would allow insurance companies to charge higher rates for a pre-existing condition for people who had a lapse in health insurance coverage.
But those higher premiums could be charged only if states also established a so-called high-risk pool or provided some other type of financial assistance that would help those people buy insurance.
Ryan held up the Badger State as a model for how things could work under the GOP bill, saying:
In Wisconsin, we had a really successful high-risk pool. Ten percent of the people in the individual market in Wisconsin were in the state high-risk pool. They had eight or nine plans to choose from. They could go to any doctor or any hospital they wanted. And their premiums and co-pays were cheaper than they are under Obamacare today.
We'll check Ryan’s three-part claim, which he repeated on the Fox News Channel.
He’s essentially on target on the first two parts, but not on the third.
What’s a high-risk pool?
The nonprofit Kaiser Family Foundation helps explain the rationale for creating high-risk pools: the sickest 10 percent of the population accounts for nearly two-thirds of all health spending.
But questions remain about the effectiveness of high-risk pools and whether there would be enough public dollars allocated to them under the GOP bill to make insurance affordable for people with preexisting conditions.
Wisconsin’s high-risk pool "was a lifesaver" for those it served, Kaiser health reform and private insurance senior fellow Karen Pollitz told us. But it served only some of the people who were eligible, and for it to be viable nationally, "you would have to put down a whole lot of money, more than has been put in the House bill so far," she said.
Wisconsin’s high-risk pool -- the Wisconsin Health Insurance Risk-Sharing Plan -- operated from 1979 through 2013. It was funded through policyholder premiums, reduced payments to health care providers and financial assessments on health insurance companies.
At the end, it insured 21,000 people and was regarded as among the most successful programs in the country, even though not everyone with preexisting conditions who needed coverage could afford it. Also, Wisconsin’s high-risk pool did not contain the same coverages as Obamacare plans -- for example, it had a lifetime limit for benefits, whereas Obamacare does not.
So, understanding the limited nature of Wisconsin’s high-risk pool, we go to the three parts of Ryan’s claim.
Ryan was close on the number of plans available in Wisconsin’s high-risk pool. There were seven options (not eight or nine) in place with deductibles ranging from $1,000 to $7,500, although one was only for Medicare recipients seeking supplemental coverage.
Ryan also was close on provider availability. All hospitals and doctors who were Medicaid-certified could be used by high-risk pool recipients. That included all hospitals in the state and the vast majority of doctors, said Sam Austin, a health policy analyst at the University of Wisconsin-Madison Population Health Institute and the author of a 2013 Wisconsin Legislative Fiscal Bureau report on the state’s high-risk pool.
Finally, Ryan’s staff pointed out that Wisconsin’s deputy insurance commissioner has told Congress that people in the high-risk pool had to pay more for coverage under Obamacare.
But it can’t be flatly stated that all premiums and co-payments in the high-risk pool were lower than those under Obamacare, Austin and other experts told us. As we noted, under options available in the high-risk pool and under Obamacare, premiums, deductibles, coverages and subsidies all vary.
Kaiser’s Pollitz told us that if medical inflation were taken into account, the Wisconsin high-risk pool costs would generally be higher than the current Obamacare rates. And high-risk pools expert Jean Hall, a Kansas University health policy professor, told us that low-income people who qualify for subsidies under Obamacare are getting more coverage for less money than they were with Wisconsin’s high-risk pool -- even if there were cases where people with higher incomes got a better deal with the pool.
Ryan says that before Obamacare, Wisconsin’s high-risk pool for health insurance "had eight or nine" plans to choose from, people "could go to any doctor or any hospital they wanted, and their premiums and co-pays were cheaper than they are under Obamacare today."
The House speaker slightly overstates the number of plans and the availability of providers, but is generally on target. But it can’t be flatly stated that the high-risk pool plans were cheaper than Obamacare plans for comparable coverage.
For a statement that is partially accurate, we give Ryan a Half True.
ABC News, video of "This Week" Paul Ryan interview, May 7, 2017
PolitiFact Florida, "Does the GOP's new health care bill still cover pre-existing conditions, as Trump claims?" May 1, 2017
PolitiFact Florida, "PolitiFact’s guide to the GOP amendment to health care bill," April 28, 2017
PolitiFact Florida, "What’s in the House health care bill?" May 5, 2017
PolitiFact North Carolina, "Does new version of the AHCA protect coverage for pre-existing conditions?" May 4, 2017
Kaiser Family Foundation, "High-Risk Pools For Uninsurable Individuals," Feb. 22, 2017
Interview, Kaiser Family Foundation health reform and private insurance senior fellow Karen Pollitz, May 15, 2017
Kaiser Family Foundation, "High-Risk Pools as Fallback for High-Cost Patients Require New Rules," Jan. 23, 2017
Wisconsin State Journal, "Obamacare repeal could involve high-risk pools like Wisconsin's," Feb. 23, 2017
Wisconsin Legislative Fiscal Bureau, "Health Insurance Risk-Sharing Plan," January, 2013
Wisconsin Legislative Audit Bureau, "Health Insurance Risk-Sharing Plan," June 2015
U.S. Senate Committee on Homeland Security and Governmental Affairs, testimony of Wisconsin deputy insurance commissioner J.P. Wieske, Sept. 15, 2017
Email, Network Health director of risk adjustment and former Wisconsin high-risk pool operations director Josh Weisbrod, May 16, 2017
National Conference of State Legislatures, "Coverage of Uninsurable Pre-existing Conditions: State and Federal High-Risk Pools," Jan. 3, 2017
Milwaukee Journal Sentinel, "New health care law spells end to state's high-risk insurance program," Aug. 31, 2013
The Hill, "Ryan's home state highlights challenge for GOP high-risk insurer pools," April 28, 2017
CNN Money, "High-risk pools won't match Obamacare's protections for pre-existing conditions," May 23, 2017
Email, Jon Peacock, research director for the Wisconsin Council on Children and Families, May 16, 2017
U.S. House Energy and Commerce Committee, testimony from Wisconsin deputy insurance commissioner J.P. Wieske, Feb. 2, 2017
Interview, Wisconsin Association of Health Plans senior executive officer Phil Dougherty, May 15, 2017
Interview, Kansas University health policy and management professor Jean Hall, May 16, 2017
Modern Healthcare, "Why high-risk pools won't crack the pre-existing condition dilemma," Feb. 13, 2017
Commonwealth Fund, "Why a National High-Risk Insurance Pool Is Not a Workable Alternative to the Marketplace," December 2014
Interview, Harold Pollack, professor in the School of Social Service Administration at the University of Chicago, May 16, 2017
University of Wisconsin-Madison Population Health Institute’s "health policy analyst at the UW-Madison Population Health Institute, Sam Austin, May 15, 2017
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