Pre-Existing Condition Insurance Plan

Amid disappointing enrollment, the government has taken steps to make the program more attractive to people with preexisting health conditions.

One of the most popular provisions of the Patient Protection and Affordable Care Act during the debate leading up to its passage was the ban on insurers excluding patients with pre-existing conditions. While the blanket prohibition does not kick in until 2014, a Pre-Existing Condition Insurance Plan program will offer uninsured adults with pre-existing conditions coverage in special state-based “pools” in the interim.

The Pre-Existing Condition Insurance Plan program will be operated by some of the states themselves and, in other states that have chosen not to take on this role, by the federal government.

The authors note that the $5 billion that Congress appropriated for the program is generally recognized as insufficient to cover all those who may be eligible until the broader reforms take effect. They conclude that although Congress specified a number of requirements for the program, difficult decisions may still have to be made about who is eligible, and what health care services will be covered, in order for the plans to stay within the spending constraints.

This Health Policy Brief describes recent changes and discusses implications for the program and the Affordable Care Act, and was published online on June 13, 2011 in Health Affairs.