NASE News

Americans With Pre-Existing Health Conditions Gain Health Coverage

Although the Affordable Care Act (PL 111-148) became law in March 2010, many of its provisions will not go into effect until as late as 2014. One provision of the legislation that has yet to take effect is a new consumer protection provision that prevents private insurance companies from discriminating against or refusing insurance to patients with pre-existing health conditions.

To fill the gap until 2014, the Department of Health and Human Services (HHS) rolled out a new program in July 2010 aimed at insuring those who have been unable to obtain health insurance due to their pre-existing conditions.

If a patient is denied insurance by a private insurance company because of a pre-existing condition and has been uninsured for at least six months, he or she becomes eligible for the government’s Pre-existing Condition Insurance Plan (PCIP).

In May 2011, HHS reduced premiums and eased eligibility requirements in an effort to increase enrollment in the plan. In 17 states and the District of Columbia, premiums were lowered by as much as 40 percent. Furthermore, in 23 states and the District of Columbia, individuals applying for coverage can now demonstrate eligibility by providing a letter from a doctor to show they have a pre-existing condition, which makes applying for PCIP easier.

Even so, according to an article in the Wall Street Journal, critics say PCIP may be “too pricey, cumbersome and unrealistic to reach the right people.” For instance, even with the lower premiums, the insurance is still expensive compared to more traditional, employer-sponsored coverage. Furthermore, the requirement that enrollees be uninsured for six months is often too risky for sick individuals urgently in need of care.

Because of these issues, fewer than 22,000 Americans have signed up for coverage, well short of the expected 375,000. The Department of Health and Human Services plans to continue outreach programs in order educate Americans about the existence of the plan.