Senate Health Bill Revision May Lead to High-Risk Pools

Senator Ted Cruz’s proposal is designed to win Republican votes on Obamacare repeal, but it may lead to higher premiums for people with diabetes.

Editorial credit: Andrew Cline / Shutterstock.com


A new proposed change in the Senate health bill may very well bring back high-risk pools for people with diabetes, and a top Trump administration official has given verbal support to it.

Vox is reporting that Senator Ted Cruz is offering a proposal which would allow insurance companies to offer health plans which do not meet the minimum standards under the current rules of the Affordable Care Act (ACA). These plans could even exclude people from coverage based on preexisting conditions, according to the report. Senator Cruz’s plan would only allow insurance companies to offer these plans if they also offered plans in a state that would comply with the rules of the ACA.

The plan is being introduced as a compromise designed to win 52 votes in the Senate among the Republican caucus. The effort to repeal and replace the ACA has stalled in the Senate because Majority Leader Senator Mitch McConnell (R-KY) has not been able to present a bill that appeals to both the moderate and the conservative wings of the Republican caucus in the Senate. No Democrat is expected to vote for the current plan, and that leaves Senator McConnell with few votes to spare to pass the legislation.

Read more: How the Senate Obamacare repeal bill would impact people with diabetes

One of the ACA’’s most popular provisions has been that insurance plans cannot charge more for premiums for people with preexisting conditions like diabetes. An early version of the Senate health plan would have kept that regulation intact, but would also have allowed insurance companies to apply for waivers to not provide some essential services, including, possibly, coverage for drugs like insulin.

GQ commentator Jack Moore points out in a recent column that this plan might very well be a backdoor way to rescind protections against higher premiums for those with preexisting conditions. Moore argues that the effect of such a plan would be that healthy individuals would migrate toward cheaper insurance plans which don’t meet ACA standard, and high-volume users of health care would be the only ones who sign up for the ACA-standard health plans. If this were to occur, he argues, the price of premiums for ACA-standard plans would quickly increase. Such a scenario would mean that the ACA-standard plans would become like high-risk pool insurance plans that existed before the ACA was enacted.

Read more: High-risk pools likely to return with ACA replacement plan

The Cruz revision likely would not address the drastic cuts in Medicaid proposed by the Senate health plan. A Congressional Budget Office report found that these proposed Medicaid cuts, along with reduced subsidies, would lead to 22 million fewer Americans being insured by 2026.

Axios is reporting that White House legislative affairs director Marc Short has said that he hopes the proposal will be part of the process to “bringing everybody together.” According to another Axios report, Senate Republicans have asked the Congressional Budget Office to score the Senate health bill with and without the Cruz proposal. Senate Republicans are expected to try and take up the bill when they return from a July 4th recess.

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Craig Idlebrook is a past editor for Insulin Nation, Type 2 Nation, and Información Sobre Diabetes. He is now the community engagement and content manager for T1D Exchange.