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For Utahns With Pre-Existing Conditions, Returning To High-Risk Pools Creates Worries

Courtesy of Eric Temple
Ogden resident Eric Temple, who had health insurance through Utah's high-risk pool for his diabetes before the Affordable Care Act.

On Thursday, House Republicans voted to repeal the Affordable Care Act and replace it with the American Health Care Act. One of the most controversial parts of that replacement is bringing back high-risk pools. Those lump together people with expensive pre-existing conditions into a smaller, subsidized group. The idea is that brings down insurance prices for healthier people. Ogden residents Eric Temple and his wife both have pre-existing conditions.

They were insured through Utah’s high-risk pool before Obamacare. KUER's Erik Neumann sat down with Temple to learn about his situation and how this health plan worked for him. Below are selected excerpts from their interview. 

Q: Congress is considering this amended version of the American Health Care Act right now. It has this amendment called the MacArthur Amendment, which allows states to waive the requirement to cover people with pre-existing conditions if they create a high-risk pool to give them coverage. Would you be concerned about that option or would that be a good option?

The big problem with high-risk pools is that you’ve got all your sick people in one place and then you’re dependent on the whim of the government every fiscal year to keep funding it. And so, depending on how the winds blow they may or may not continue to do it, and so it feels tenuous. And when you’re struggling with a spouse that has cancer or a chronic condition, the last thing you want to worry about is: is my health insurance going to be there next year?

Q: How do you compare the coverage of being in a high-risk pool to being in Obamacare?

Under Obamacare, we have full coverage. My wife’s medicine for bone cancer which is related to breast cancer that she had seventeen years ago, you know, that would be $15,000 per month for life. We might be able to squeeze a month or two of that medicine out of our pocket, but there’s no way we could keep it going. Without that, her bone cancer would get worse and eventually she would die sooner.

Q: Would that be because you’d be maxing out this limit that you could spend?

In a high-risk pool, for example the one I was on here in Utah, had a $1.5 million lifetime cap. Just to give you an example, when my wife had breast cancer back in 2000, our bill after a year of treatment for everything she had was half-a-million dollars. And that was picked up by insurance but had her cancer come back sooner and we were still on a high-risk pool, we would have hit the cap.

Q: What are you concerned about with this possibility of a high-risk pool going forward?

If we ended up in a situation where ACA goes away and Utah hasn’t set up a high-risk pool yet we would probably end up looking at all the states in the union and finding out which one has the best high-risk pools or the best coverage for people like us and I would have to pick up and move, which would be a huge expense and hassle and all that. I don’t want to leave Utah, I love it here.

Q: And the subsidies that the state or the federal government would be paying to sort of buoy up that high-risk pool, you don’t think would be enough?

They’re already underestimating how much it will cost when Congress is now talking about the new AHCA. I worry that it is going to be severely underfunded and more of a token effort, rather than an effort designed to help people in need. I understand that elections have consequences and all that but I really think that this should be a nonpartisan issue. Everybody gets sick at some point in their lives. Everybody needs a hand at some point in their lives. I think we’re bigger than this as a country. It is too easy to fall off the edge and be uncovered in this country and it’s too easy to go medically bankrupt, on top of the stress of having the illness and whatnot. 

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