Washington, D.C. – Congressman David Schweikert introduced H.R. 7003 to amend the Public Health Service Act to establish a health insurance Federal Invisible Risk Sharing Program.

According to Kaiser, 10% of the sickest individuals account for nearly two thirds of population health spending (graph below). This means that healthier individuals are covering the costs of a small number of high cost patients. This is especially true in the individual ACA marketplace because there is a smaller insurance pool for these costs to be allocated, as opposed to the large group or private market where costs can be disbursed over a larger number of people – the cost exposure to any one individual is limited.  

The Federal Invisible Risk Sharing Program gives insurers the ability to recoup the extraordinary costs of their highest cost patients without resulting in higher costs for healthier individuals participating in the marketplace. The Program seeks to ensure individuals have access to affordable health insurance at the lowest possible rates, whether they have a pre-existing condition or not.

H.R. 7003 offers predictability to the individual marketplace for individuals and insurers and, over time, gives states the ability to manage the program based on their own needs. This is a proven model to provide affordability and stability to the health insurance marketplace.

The full op-ed can be read here. 

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