High-Risk Pools Could Return To Kansas Under New Federal Health Care Law

Mar 8, 2017

Kansas' newest member of Congress is at the center of the emerging Obamacare repeal-and-replace debate. Republican Roger Marshall – a doctor from Great Bend – is quick to call the health reform law a failure.

But the replacement bill that he supports – which was introduced this week – is drawing fire from both constituents and health policy researchers. 

Everyone was all smiles recently when Congressman Roger Marshall cut the ribbon at his new district office in Salina.

But things got a lot more contentious when constituents started peppering him with questions -- questions about how the Republican replacement plan would protect sick people who often couldn’t get affordable coverage before Obamacare.

Among other challenges, Marshall and others trying to sell the Republican plan have a rhetorical problem. They have to reassure people that scary-sounding “high-risk pools” are better than “guaranteed issue” provision in Obamacare. It prohibits insurance companies from denying coverage to people with pre-existing health conditions.

“They do not work very well, unfortunately," says Jean Hall, a University of Kansas researcher who has written extensively about high risk pools for several national health policy organizations.

Related: 4 Challenges Trump And Republicans Face When It Comes To Health Care

Before Obamacare, 35 states – including Kansas and Missouri – operated such pools. But, Hall says, a combination of high-premiums, thin coverage and enrollment limits often made them ineffective.

“What we found in Kansas was that premiums were very high and the coverage was very limited," Hall says. "So, you have people with chronic conditions who don’t have access to very comprehensive care.”

"They do not work very well, unfortunately."

Studies found that only a fraction of the people who needed high-risk pool coverage were able to afford it.

Jennifer Weishaar, from Lawrence, is one of those who couldn’t.

"The premiums were exorbitant at that time," she says.

Weishaar suffers from polycystic ovary syndrome, a chronic disorder that often leads to diabetes and sometimes cancer.

She says she couldn’t afford regular check-ups until she got an Obamacare plan. Only then did doctors discover and remove several large polyps from her colon.

“And so there is a very real line for me from having insurance to being able to go to the doctor to having this found and not having colon cancer at age 36 or not being dead," she says.

One of the aims of Obamacare was to dilute the cost of covering people with chronic health conditions by including them in as big an insurance pool as possible. But because not enough young, healthy people bought coverage in the Obamacare marketplace, the added risk forced premiums up for everybody who did.

Going back to high-risk pools would once again segregate that risk. And Hall says the $100 billion the replacement bill allocates to fund the pools won’t be enough to make premiums affordable unless states also chip in millions of dollars.

“That’s probably what would happen is that states would have to come up with a lot of additional funding. Substantially more than that," Hall says. "Assuming that they want to make it affordable for people, yes.”

The political debate aside, it’s Julie Holmes’ job to be ready. She’s the director of the health and life division at the Kansas Insurance Department. She says if the replacement bill that Congress passes re-establishes state high-risk pools, Kansas lawmakers could act quickly. That’s because the law authorizing the state’s old pool is still on the books.

“From that perspective, we’re ahead of the game," she says. "A lot of states have dismantled it and maybe don’t have their statutes still in place. So, we wouldn’t have to necessarily recreate the wheel, but it would definitely have to be re-worked to fit whatever it is that comes down the pike.”

Emphasis on the word “whatever" -- because while Republicans in Congress are united in their desire to repeal Obamacare, they’re divided on exactly how to do it.

Jim McLean is managing director of KMUW's Kansas News Service, a collaboration of KMUW, Kansas Public Radio and KCUR covering health, education and politics in Kansas. Follow him on Twitter @jmcleanks.