RYAN'S HIGH-RISK PRETENSE NOT HEALTH SOLUTION

By Dominique Paul Noth

Paul Ryan makes laughable claims about
Wisconsin high risk pool.

As a journalist I got deeply irritated with my Washington-based counterparts for allowing Paul Ryan at his press conference to praise Wisconsin’s high-risk pool for setting a model for covering people with pre-existing conditions and otherwise lapsed insurance coverage.  Wish they had asked the people.

I was further irritated May 3 when GOP moderates offered a high-risk pool amendment sweetening the money pot for the states by adding $8 billion over five years – while the experts say it would actually cost $171 billion a year over the Affordable Care Act now and still require higher premiums, deductibles, and caps on life-time coverage.  All this in the name of saving money!

Well, Ryan was not challenged by the press then, though his attitude has long been laughed away by experts. But I’m challenging now, after having heard from many who had bad memories of participating.  Turns out they were respectable people I know, such as a friend forced into the high risk poll after his job ended.

Coverage was average, certainly not as comprehensive as (the plan I had).  Deductible was high. And the premiums were breathtakingly expensive. So Gov. Walker and Rep. Ryan: it did not work well for this customer.

Medical experts clearly agree that Paul Ryan is once again talking through his hat.

Yet high risk pools are key to the new Republican health care bill, which is still scrounging for votes. It is a central reason, along with strange female health no-nos on acceptable heath plans. The Republicans are unlikely to succeed with any legislator who studies the details of the bill, even newly amended whispers. Trump apparently doesn’t understand it and Ryan is allowed to lie about its “improvements.”

Two of us were forced into the high-risk pool in 2005 because of pre-existing conditions after my COBRA expired, and the premiums were brutal. One year, for the two us, the premiums were $2,000 monthly and $24,000 annually -- you definitely needed substantial income to make just the monthly premium payments.

(COBRA incidentally is the abbreviation for the Consolidated Omnibus Budget Reconciliation Act of 1985,  a law passed by Congress signed by President Reagan to keep most  employer group health plans -- at high cost --  for a limited time after your employment ends.)

I have a theory about health coverage – that people’s eyes roll out of their heads when a technical issue is being talked about on television.   What is a high risk pool? Well, it’s not only for those who can’t get insurance because of pre-existing conditions, such as a cancer that rendered them uninsurable under the old system Ryan wants back. It also was a safety valve for people who retired or were forced to leave their company before Medicare kicked in.  It involves a complicated procedure by health providers to determine who is eligible – in other words, more power to the very people who make money by charging you.

That means politicians can get away with untruths a lot, so you had better cast issues like high-risk pools into everyday language – and use the experience of actual participants as rebuttal.

Ryan failed to mention a lot of things when he described how Wisconsin had led the way in high risk pools and claimed it was a good idea. Yet it was actually rated as one of the better pools. Problem was, by whom and for whom? 

Largely he was repeating claims made in February to a House Energy and Commerce Committee that have since been clarified and explained as far more limited by the testifier – J. P. Wieske, Wisconsin’s deputy insurance commissioner. He later admitted that high premiums did cause an affordability problem and that his research never quantified the numbers it helped.  Basically it seems to have aided those who could afford it. 

(Turned it down because) it would have cost me about $1300 per month. That didn't cover most of the things I had. Another political talking point, but had nothing of substance.

Ryan also failed to mention the paucity of participants and how all the nation’s high risk pools lost money. Wisconsin’s high risk pool was created in 1979. It operated until the Affordable Care Act took over, eliminating the need for those with pre-existing conditions to search under rocks for coverage. At its height it only covered 22,000 citizens.

That’s compared to the million or more nationwide who had been rejected for affordable insurance coverage because of pre-existing conditions and similar reasons.  Despite what some Republicans have claimed – that bad health is usually brought on by living habits – there are profound examples where this is simply not true. 

On May 1, TV host Jimmy Kimmel gave a  moving account of how his son, born with a rare heart condition, under ACA no longer had to worry about pre-existing conditions to find coverage even though his son faces two more operations into his teens. Kimmel didn’t mention the obvious – his son could die if he wasn’t rich and the Republican health plan moved forward.

Much of the objection to the GOP health plan is how Trump insists that pre-existing conditions are covered. Here we have a president who doesn’t even look at the wording and then blames the Democrats for exaggerating. The plan is about access to such coverage, nothing about cost savings if states now get the power to decide what health issues outside the core can be charged consumers.

The Kaiser Foundation points out that Wisconsin was part of a national effort to bridge the gap for these citizens until the online marketplaces got going in 2014.  So federal money became involved then – with the ACA -- where high risk pools in the past relied on 60% payment by enrollees' premium payments, 20% by assessments on Wisconsin insurers, and 20% by provider discounts. 

The states and Ryan liked the program because it didn’t cost the taxpayers a dime then,  required a six month waiting period and a complicated approval process. Even if federal money is now made available, it’s hard to imagine states like Wisconsin suddenly becoming generous with support.  Look at how Walker keeps reducing the coverage under Medicaid, also partly paid by the feds.

Many participants back then have told me they were forced into the program because of insurance circumstances and they don’t want that game back in any shape or form.

My premium in Wisconsin's high risk pool was about $1000/month. Not sustainable at all!

About the author: Noth has been  a professional journalist since the 1960s, first as national, international and local news copy editor at The Milwaukee Journal, then as one of the editors for its original Green Sheet, also  for almost two decades the paper’s film and drama critic. He became the newspaper’s senior feature editor, then was tapped by the publishers of the combining Milwaukee Journal Sentinel for special projects and as first online news producer before voluntarily departing in the mid-1990s to run online news seminars and write on public affairs and consumer news. From 2002 to 2013 he ran the Milwaukee Labor Press as editor. It served as the Midwest’s largest home-delivered labor newspaper, with archives at milwaukeelabor.org.  In that role he won top awards yearly until the paper stopped publishing in 2013. His investigative pieces and extensive commentaries are now published by several news outlets as well as at his culture and politics outlets known as Dom's Domain.  He also reviews theater for urbanmilwaukee.com.