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Republicans and Risk Pools



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House Republicans have had at least temporarily to abandon a bill to redirect some Obamacare spending away from the program’s propaganda division to its risk pools that actually help sick people. BuzzFeed carried a somewhat overcaffeinated account of the conservative divisions over the bill.

In that account, staffers for Senator Ted Cruz (an old friend, as readers must be getting tired of my writing) were “working actively to undermine” the bill’s chief proponent, House majority leader Eric Cantor. This seems to me overblown. If someone asked Chip Roy, Cruz’s chief of staff, what he thought about the bill and he said he disagreed with what the House leaders were doing, would that count as “working actively to undermine” Cantor in “an unheard of breach of Capitol decorum”? If the answer is “no,” as it should be, why should expressing his opinion on a private email chain be any different? It’s not as though Roy actually organized a campaign against the bill. Cantor, his staff, and his allies on this bill might reasonably be exasperated that other Republicans are taking a view they find wrongheaded. But there’s no legitimate cause for them to feel aggrieved by the Cruzers’ actions, and Buzzfeed doesn’t even suggest that they do feel that way.

I take the same view of the bill that NR’s editors do: The Cantor bill makes sense as part of a general anti-Obamacare strategy, but conservatives are bound to be suspicious of it until Republicans actually adopt such a strategy. Whether the House adopts the tactic of passing this bill strikes me as less important than that Republicans get that strategy, including an alternative to Obamacare, right. And the problem with the Cruz aides’ quotes is not so much where they come down on the tactical dispute as the arguments they make about high-risk pools.

Most Republicans, including some opponents of the Cantor bill, favor funding high-risk pools, which were part of the House Republican alternative to Obamacare in 2009–10. The Cruz aides expressed hostility to these pools in principle as a kind of big-government approach to health care. They argue that the conservative financial economist John Cochrane has shown that “liberty solves the problem” of people with pre-existing conditions, so that federally-funded risk pools are unneeded.

I think the Cruzers are right to suggest that the problems that sick people have in getting health insurance are largely the result of misguided government interventions in health care. If the states and the federal government had not done so much to stunt the growth of the market in individually purchased health insurance, it would probably be much easier for people to buy products that would let them maintain continuous coverage through sickness and health. Cochrane has outlined what one such product would look like: “health status insurance” that gave policyholders the ability to buy insurance at affordable rates even after they got sick.

That’s a reason for thinking that reforms to free health-insurance markets would cause the problem of people with pre-existing conditions to diminish over time, maybe even to come close to disappearing. What it isn’t is a solution for people who already have pre-existing conditions. That’s why high-risk pools have to be part of any conservative reform of health care: to provide direct help for the people whom longstanding government policies have rendered uninsured and uninsurable.

According to the BuzzFeed article, the Cruz aides argue that government help for people with pre-existing conditions undermines the point of getting insurance. That’s true for some forms of help: specifically, for outlawing risk-rating by insurers. That policy makes buying insurance into a chump’s game (since you can wait until you’re sick to get insurance). Then the government has to force people to buy coverage. Well-designed high-risk pools, on the other hand, are a necessary part of any transition to a freer health-care market. That’s why conservatives ought to support them.



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