Healthcare Business News

GOP backs prevention cuts to fund high-risk pool

By Jonathan Block
Posted: April 17, 2013 - 6:00 pm ET

House Republicans moved to divert money from the healthcare reform law's prevention and public health fund to shore up a program the law created to give temporary relief to Americans who can't otherwise afford health insurance because of pre-existing conditions.

The committee voted 27 to 20 along party lines to approve H.R. 1549, known as The Helping Sick Americans Now Act.

The legislation would fund the Pre-Existing Condition Insurance Plan through the remainder of the year. HHS suspended enrollment in February after the $5 billion appropriated for it ran dry. To pay for re-opening enrollment for the next seven months, the bill would transfer $4 billion from the Prevention and Public Health Fund, a provision of the Patient Protection and Affordable Care Act that Republicans have repeatedly targeted for repeal and criticized as a slush fund for the administration.

Advertisement | View Media Kit


The state-based high-risk pools were meant as a stopgap measure until the Jan. 1 launch of new insurance options in the law's health insurance exchanges and new regulations that prohibit insurance companies from denying coverage or charging exorbitant premiums for people with pre-existing health problems.

In a 2010 memo, the CMS' chief actuary estimated that the program would run out of money in a year or two. And while PCIP was expected to provide coverage to 375,000 people, just over 107,000 were enrolled as of Jan. 31. The CMS attributed the lower enrollment and higher costs to the difficulty of placing people with extremely high and variable medical costs in distinct risk pools, according to an annual report issued in January (PDF).

House Democrats agreed the program needs additional funding, but they see the bill as another attempt by Republicans to gut certain parts of the Affordable Care Act. “You're robbing from one public health area to” pay for another, said Rep. Henry Waxman (D-Calif.), ranking member on the committee.

Rep. Michael Burgess (R-Texas), a physician, said he did not see a problem with transferring the money from the prevention funding because “there's a big bunch of money there lying inert.”

Rich Hamburg, deputy director of the Trust for America's Future, a public health advocacy group, disputed that characterization. “These are dollars that are committed to improving the nation's health and wellness,” Hamburg said in an e-mail. “So far, with fiscal 2013 allocation (figures) posted yesterday, we have seen $3.25 billion in prevention of public health funds invested, most of that money going toward prevention, public health and wellness.”

Rep. Frank Pallone Jr. (D-N.J.) introduced a bill (H.R. 1578) Tuesday that would replenish the program's funding with a 4-cent a pack federal cigarette tax.

Follow Jonathan Block on Twitter: @MHjblock

What do you think?

Share your opinion. Send a letter to the Editor or Post a comment below.

Post a comment

Loading Comments Loading comments...



Switch to the new Modern Healthcare Daily News app

For the best experience of on your iPad, switch to the new Modern Healthcare app — it's optimized for your device but there is no need to download.