A commonsense healthcare solution

"...Most of our nation’s healthcare spending is spent on a small percentage of very sick people. These individuals account for a large portion of insurance companies’ expenses..."

"My colleague Rep. David Schweikert from Arizona and I introduced legislation this week that addresses this issue. H.R. 7003, establishes a Federal Invisible Risk Sharing Program. This works by allowing insurance companies to identify their small percentage of high cost patients and place them in the Invisible Risk Sharing Program..."

"The result is that every patient has access to affordable health insurance coverage at the lowest possible rates, as if they were perfectly healthy."

"This is achieved by allowing those with health conditions that would result in either unaffordable premiums or increased costs for healthy patients to have their high healthcare costs paid by the Invisible Risk Sharing Program. The Program is “invisible” because patients do not know whether they are placed in the Program or not. Their coverage is the same, at the same low rates, regardless of their health. This government backing for those patients that are extremely costly for insurance companies to insure provides insurance companies and the market the stability they need to keep costs down for all.

"This has been proven to work. In 2011, Maine created an Invisible Risk Sharing Program and rescued itself from its health insurance market’s death spiral. Maine improved the rate of health insurance coverage for those with pre-existing conditions and young, healthy enrollees who had been fleeing the insurance market for years — all at lower cost.

"The Federal Invisible Risk Sharing Program is funded with $15 billion federal dollars per year and 90% of premiums collected from the patients that the insurers designate for the Program. Insurers will be required to cover the first $7,500 of their patients’ expenses. By requiring insurers to contribute most of the premiums received from their high-risk patients they have no incentive to game the system. Gaming the Invisible Risk Sharing Program would in fact bankrupt the insurance companies.

"H.R. 7003 creates a single federal program, but in three years allows states to take over management of the program for their individual state and within ten years requires the states to take over management. This guarantees it will not become a permanent federal program and gives the states a seven-year window to decide when they want to assume management responsibility. The initial federal program will cover a specific set of medical conditions that would automatically allow insurers to place patients into the program. When states assume responsibility for program management, they will be able to modify the qualifying conditions to best suit their residents’ needs..."