Attention, Mitch McConnell: More than half of Kentucky is a high-risk pool

As highlighted in my previous post, in the recent NYT/Kaiser poll of attitudes toward the ACA in four red states, an astounding 57-60% of respondents reported that someone in their household has a pre-existing condition. In Kentucky, the number was 60%.

That fact throws into stark relief Mitch McConnell's response when asked what he would do for terminally ill Kentuckians who would lose their new insurance if the ACA is repealed, as he has demanded it must be:

There are a lot of people like that, of course, who are losing what they had before, who were insured through the high-risk pool, who are losing what they had before.The way that should’ve been handled was state-based high-risk pools. Not at the federal level. Because for every one of those, you’ve got somebody who was insured and through a state-based high-risk pool, who lost their situation because they were wiped out Dec. 31 of 2013. So I’m worried about those people.

As the Louisville Eccentric Observer, an alt-weekly, points out*, the state's high risk pool covered fewer than 4,000 people in 2013 --  less than one hundredth of the 413,000 who obtained insurance this year via Kynect, the state's  ACA exchange. Ah, Mitch might respond, but not all of those 400,000 would need a high-risk pool. True -- just most of them (or else would pay through the nose for private insurance).


The LEO further notes that the state high risk pool "did not provide the same consumer protections under the ACA — with the average basic premium for an individual being $680 a month, and the most popular plan with a pharmacy rider having a monthly premium of $1,118 for a male aged 64."  Under the ACA in Kentucky, the base premium for the cheapest silver plan, offered by KY Health Cooperative (which well undersold the major commercial insurers), ranges from $450-$520 per month, with a $2,000 deductible,  a $20 copay for generic drugs, and a $40 copay for preferred brand-name drugs after the deductible is met. The cheapest bronze plan is about $85 per month cheaper. Those prices are exclusive of subsidies, for which the majority of the uninsured in Kentucky qualify.

McConnell's obfuscation goes deeper than offering a non-solution. In his comments about the ACA, he has for months asserted that most signups for private plans are people who previously bought insurance in the individual market and have since been forced to buy more expensive and more restrictive insurance on the ACA exchanges.

That is certainly not true in Kentucky. Of the 83,000 who signed up for private plans on Kynect, certainly over 83%, the national average, qualified for subsidies. In any case, most of the signups -- 330,000 -- qualified for Medicaid in the high-poverty state, which ranks 45th nationally in median household income.

In the Times/Kaiser poll, 10% of respondents in Kentucky said that they bought private insurance, either on the state exchange or directly from an insurer.  If that is accurate, there may be somewhere north of 300,000 Kentuckyans insured via plans purchased privately off-exchange.  Some of them doubtless suffered rate shock -- if they and everyone in their household whom they sought to insure were healthy. But recall that 60% of those polled also said that someone in their household has a pre-existing condition. These buyers would mostly do better under the ACA than previously, even though they either did not qualify for subsidies or simply failed to access them.

Viewed another way, of the holders of 130,000 individual plans active in the state in 2013 that the Kentucky Insurance Department estimated might be affected by the Affordable Care Act, not only would a majority would be eligible for ACA subsidies (that's the case nationally, according to the Urban Institute, and Kentucky his a poor state). It's also likely that more than half would benefit from the ACA's ban on medical underwriting -- the pricing of insurance according to plan members' medical history. That ban is the main driver of price increases for some healthy and relatively wealthy buyers in the individual market under the ACA.

So McConnell not only wants to replace the ACA with a past program that insured 1/100 as many people, he also effectively proposes to re-subject his constituents to medical underwriting, notwithstanding that 60% of those lacking access to employer-sponsored insurance would suffer because of the reversion.

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* Hat tip to the Plum Line.