The 2010 health law, also known as Obamacare, forced insurers to sell coverage to anyone, at the same price, regardless of their risk of incurring big claims. That provision was popular. Not so were rules requiring nearly everyone to have insurance, and higher premiums for healthy people to subsidize the costs of the sick.
If policyholders don’t pick up the tab, who will? Letting insurers refuse to sell to individuals with what the industry calls a “pre-existing condition”—in essence, forcing some of the sick to pay for themselves—is something both parties appear to have ruled out. Insurers could charge those patients more or taxpayers could pick up the extra costs, two ideas that are politically fraught.
Most U.S. health-care spending is for a small number of very expensive patients:
- -Most expensive 1% of patients = 21% of health care spending.
- -Most expensive 5% = 49%
- -Most expensive 10% = 65%
- -Most expensive 15% = 75%
- -Most expensive 20% = 82%
- -Most expensive 50% = 97%