House Republicans might not be waiting around for the Congressional Budget Office to tell them what the latest version of the American Health Care Act will actually do, but that hasn’t stopped outside experts from trying to illustrate what an unruly mess the legislation will be. (Update, 2:35 p.m.: The bill passed the House on a 217–213 vote.) The health industry consultants at Avalere estimated how many Americans with pre-existing conditions could be covered by the $130 billion GOP lawmakers initially set aside to potentially fund high-risk pools, which would provide subsidized coverage for sick people priced out of the normal private market. The answer: about 600,000 Americans, out of 2.2 million people currently in the individual market with pre-existing conditions. Here’s the key bit:
New research from Avalere finds that the funding ($23 billion) specifically allocated in the American Health Care Act (AHCA) to assist individuals with pre-existing conditions will only cover approximately 110,000 individuals with a pre-existing chronic condition. If states were to allocate all the other funds in the Patient and State Stability Fund ($100 billion) toward providing insurance to people with pre-existing conditions, in addition to the funding described above (total of $123 billion), 600,000 individuals with pre-existing chronic conditions could be covered.
Approximately 2.2 million enrollees in the individual market today have some form of pre-existing chronic condition.
Some might object that not every state will need to establish high-risk pools, because liberal lawmakers in places like California and New York aren’t likely to waive Obamacare’s protections for pre-existing conditions. But blue states will still get their shares of the $100 billion patient stability fund, which provides the bulk of potential high-risk pool funding (it can be used for other purposes as well, like keeping the wider individual market steady through reinsurance and such). That means conservative states will still likely face big funding shortfalls in their high-risk pools.
But hey, that extra $8 billion from the Upton amendment should fix everything, right?