GOP Leaders: Refashion Obamacare To Address Preexisting Conditions In The Short-Run

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House GOP leaders say they want to help people with preexisting conditions, and now.

After years of scorched-earth opposition to the Affordable Care Act, they recognize that appearing opposed to the law’s well-liked coverage guarantee for sick people — around which much of the rest of “Obamacare” is built — is a political vulnerability.

So this week, Speaker John Boehner (R-OH), Majority Leader Eric Cantor (R-VA) and five others wrote a letter calling on President Obama to support the transfer of money from Obamacare’s prevention and wellness fund to a temporary program designed to protect sick people before the law’s preexisting condition guarantee takes effect in 2014.

“We believe allowing those with pre-existing conditions access to health insurance is another worthy reason to reprogram these funds,” the GOP lawmakers wrote. “With your support, we could help these Americans get the care they need.”

Three weeks ago, the Department of Health and Human Services closed the law’s state-based high risk pools to new applicants after deciding that it was too costly and underfunded. HHS said it was “the most prudent step” given the program’s $5 billion spending limit and need to ensure coverage for existing enrollees.“Your Administration’s action will leave thousands of Americans with pre-existing conditions without access to health care,” the GOP letter reads, citing an article about the plight of a 61-year-old woman with cancer who lacks access to health care.

The House GOP has regularly sought to wipe out the prevention fund, a $15 billion program aimed at combating disease and promoting wellness. They deride it as a “slush fund.” They goaded Democrats to cut it to $10 billion early in 2012 as part of a deal to extend the payroll tax cuts and emergency unemployment compensation.

Democrats scoff at the GOP’s letter, declaring that if Republicans actually care about people with preexisting conditions, they should support implementing Obamacare.

“Unfortunately the Republicans continue to take every opportunity to try to decimate the prevention fund,” Rep. Henry Waxman (D-CA) told TPM. “The best way to take care of individuals in the high risk pool is to implement the Affordable Care Act.”

A Cantor aide, who asked not to be named, retorted: “The only way for the program to reopen enrollment is to put more money into the program. As the President said in his State of the Union address we should be doing things that don’t add to the deficit.”

Republicans are fond of floating high-risk pools as evidence that they want to deal with preexisting conditions. But as many health economists point out, they are unworkable on their own. High-risk pools, by virtue of the fact that they cover the sickest people, are very expensive. So in order to prevent a death spiral of rising costs, younger and healthier people must be in the system. But some of them cannot afford coverage and need help. Those are the three key pillars of Obamacare — a coverage guarantee, a mandate to ensure broad coverage and subsidies for low-income people. Republicans, by contrast, have thus far failed to put forth a comprehensive alternative to address preexisting conditions in an economically feasible way.

A HHS staffer said that adjustments the Department has had to make while monitoring spending closely — like lowering provider payment rates and suspending new enrollment — reflects “the need for expanding coverage to control costs.”

Drew Hammill, a spokesman for House Minority Leader Nancy Pelosi (D-CA), described the letter as “more smoke and mirrors from House Republicans who are obsessed with undermining this historic law,” also calling on them to get behind the ACA.

Read the House GOP letter to Obama, signed by Boehner, Cantor, House Majority Whip Kevin McCarthy (R-CA), Republican Conference Chair Cathy McMorris Rodgers (R-WA), Energy & Commerce Chair Fred Upton (R-MI), Energy & Commerce Health Subcommittee Chair Joe Pitts (R-PA) and Rep. Michael Burgess (R-TX).

High Risk Pool Request 3.5.13 FINAL by

ABOUT THE AUTHOR

Sahil Kapur is TPM's senior congressional reporter and Supreme Court correspondent. His articles have been published in the Huffington Post, The Guardian and The New Republic. Email him at sahil@talkingpointsmemo.com and follow him on Twitter at @sahilkapur.
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