Thursday, February 25, 2010; 4:15 PM
OBAMA: All right, Tom. The -- Dave Camp?
CAMP: Thank you very much. On the issue of insurance reform and pre-existing conditions, there are responsible ways to solve this problem and reduce the cost of health insurance for everyone.
And we support state universal access programs that address high- risk pools and reinsurance, that makes affordable coverage available to those who are sick and those who have a pre-existing condition.
And I won't go all of those -- through all of those things that Dr. Boustany and others here have talked about. But -- and our approaches are somewhat similar on this issue, pre-2014, in the period where the House and Senate bills are wrapping up -- ramping up.
But they are -- there is a pretty big distinction, and that is that there's a key difference in the approaches. We prevent waiting lists during that period, and we have these programs managed by the state level. And they're robust enough that CBO has scored that they'll be effective.
And what -- what the House and Senate approaches are is that those rules are set in Washington. And the House and Senate bills are similar in that, if you look at the Senate bill on page 48, 51 and 52, it's the unelected secretary of health and human services who has the authority to establish waiting periods for access to these programs, raise premiums, reduce benefits. And so it is a very -- while we are similar in what we talk about, there's a very key different approach there.
And then, after 2014, when the bill fully comes into play, you have a very different approach there. And what you do is establish a pre-existing condition and link it with the individual mandate. And the American people have told us they don't want to be forced to buy health insurance that they don't want and they can't afford.
And this is a significant issue across the country. And the American people are telling us that the individual -- the mandates, the requirements to buy insurance are something that they want us to scrap and start over on. And that's why you're seeing state legislatures around the country passing resolutions saying, our citizens are going to have a choice on whether they buy health care; they're going to have a choice on the kind of coverage they want to have.
And so this is a fundamental difference in this area of insurance reform that I think we -- we have to -- we have to really begin again and really take into what the American people are saying and expressing this through their elected representatives in the state legislatures. I know there's a lot of former state legislators here. I'm one as well. And I think that's a very serious point that we need to address.
OBAMA: I'll just touch on your last point, which is the whole issue of pre-existing conditions. Tom Harkin mentioned it, but I -- and I'll be very brief, because I know that we've got to move on to the next topic.
The way I understand Leader Boehner's bill works -- and I think that's the one you're referring to -- the way you deal with a pre- existing condition is to essentially set up a high-risk pool. I mean, that's the mechanism.
So what you're saying is, if you're sick or older or you've got hip replacements or what have you, and you're having trouble buying insurance on the open market, you're going to be able to buy into a high-risk pool.
Now, Tom made the point earlier that -- and this is indisputable. I don't think anybody would disagree with this, that if you set up a high-risk pool in which you don't have healthy people, younger people in the same pool as older, sicker people, the premiums for the older, sicker people, who have been segregated into this pool, is just going to be higher.
Now, I have -- you know, we looked at the Boehner bill to see, sort of, how you approach that, and you have got some reinsurance. And keep in mind, we use a high-risk pool, as well, until we get to the exchange. And we have reinsurance, for example, for federal -- or for people who are on retiree plans who want to help employers maintain those plans.
OBAMA: And they've got an older population, so we want to help reinsure them.
But given the amount of money that you have allocated for that pool, it's just not going to be a very useful tool for the vast majority of people who've got preexisting conditions, just because there's not enough money that you guys put into it to be able to cover all the people with preexisting conditions.
Which is why other states have high-risk pools. Kathleen mentioned -- they're -- I don't how many states, but let's say 20, 21 states currently have high-risk pools. Out of all those 21 states, about 200,000 people use the high-risk pool. And the reason is because by just dealing with older, less healthy individuals separately, or people with preexisting conditions, it is very, very expensive.
Tom's point was if everybody's in it because presumably none of know at any given moment who's going to end up being healthy and who's not. We don't know whether our kids are going to be suffering some sort of disease that we don't anticipate yet. Or, you know, our spouses get ill. That if everybody is in it, then that drives prices down cheaper for everybody.
So it's not that I think that the high-risk pool idea is a bad one. As I said, the House and the Senate bill, the bill -- the proposal that I put forward -- all use the high-risk pool as a stopgap measure to get to a broader pool. But the goal has to be to get everybody in a place where those risks are spread more broadly.
CAMP (?): And if I just might say, we support high-risk pools and reinsurance with $25 billion in funding. The House and Senate versions are $5 billion in funding. And because of that robust support, CBO says this will work.
The fundamental difference after that is that the health and human services secretary in that four-year period when they're somewhat similar has the authority to raise the premiums, so all that -- all of that is brought to Washington. We -- we leave that authority in the states so that they can manage their state pools.
And then after the bill becomes effective in 2014, the real problem becomes this individual -- the mandate and the cost that the forcing of the purchase of insurance, which many Americans find objectionable. And that, you can avoid that mandate if you continue to design this as we do in the beginning, and both the plans are somewhat similar on that, but it's a very different structure.