Republican vice presidential nominee Sen. J.D. Vance of Ohio on Sunday floated the idea of rolling back health insurance coverage for people with pre-existing conditions, revisiting a position that characterized Republican proposals to replace Obamacare under President Donald Trump.
In an interview on NBC's “Meet the Press,” Vance said Trump's health plan would “promote choice” in the health care system by putting sick people into a different health insurance coverage pool than healthy people.
Vance said Trump's health care plan would focus on deregulating insurance markets and “not taking a one-size-fits-all approach that puts a lot of people in the same insurance pool, the same risk pool,” while also ensuring people have access to the doctors and care they need.
Vance's comments came after President Trump said during a debate last week that he had a “vision” for an alternative if the law was repealed.
Vance described the same “high-risk pool” concept advocated by conservative House lawmakers in 2017 as they crafted an Obamacare replacement bill to fill gaps in Trump's plan.
For more than 35 years before the Affordable Care Act was passed, both Republican- and Democratic-leaning states used high-risk pools, separate from other insurance markets, to target people with high medical costs.
The general idea of high-risk pools is to keep sick, costly people out of the market in order to reduce premiums for healthy people who are typically in the market, insurance experts say.
But insurance pools were largely unsuccessful in covering those who needed it most: Without sufficient funding, people typically faced high premiums and limited coverage.
“If you put sick people in one isolated pool, premiums are going to be extremely expensive unless you have subsidies or benefits are really meager,” said Sabrina Corlett, a research professor at Georgetown University's Center on Health Insurance Reform.
“Unless we're prepared to subsidize these high-risk pools with huge amounts of tax money, it's just going to be an expensive, poor-quality slum for people with pre-existing conditions,” she said.
Still, conservatives promoted the idea as an alternative to Obamacare's “one size fits all” mandate, which created a single risk pool for everyone.
They wanted to allow states to waive the law's “community rating” requirements, which prohibit insurers from charging sick people higher premiums.
Nearly all state high-risk insurance pools excluded coverage for pre-existing conditions for periods of three months to a year, and charged exorbitant premiums even when they did cover a person's medical condition.
Many state pools have lifetime caps on covered services, and some have annual dollar limits on certain benefits, meaning cancer or diabetes patients who need expensive medicines can't get those benefits.
Obamacare has become increasingly popular since Republican attempts to repeal it were defeated in 2017.
“Right now, all political leaders are saying that people with pre-existing conditions should be protected, but the policies they advocate for don't necessarily accomplish that,” Larry Levitt, KFF's executive vice president for health policy, said in an email.
But the push to create high-risk pools continues among prominent conservatives.
For example, the Republican Study Committee’s (RSC) fiscal year 2025 budget proposes eliminating many of the existing protections for people with pre-existing conditions, including allowing states to provide separate risk pools for younger, healthier people.
The RSC also proposes restoring medical underwriting, the power for insurers to assess an individual's health risk and charge higher premiums or exclude certain benefits from plans purchased by people with pre-existing conditions.
The RSC represents 80 percent of House Republicans.
“In theory, segregated high-risk pools could adequately protect people with pre-existing conditions and keep premiums affordable, but only if these pools have sufficient government funding,” Levitt added.
But it's not clear where the money to cover these people would come from, since Republicans are largely opposed to expanding government spending.
