New report: The ACA'S PCIP serving as a bridge; High-risk pools not a long-term solution
The Pre-Existing Condition Insurance Plan, the name for the federal high-risk health insurance pool established by the Affordable Care Act, is serving its purpose as a bridge program, according to a new Commonwealth Fund report. Currently, the Pre-Existing Condition Insurance Plan is providing a coverage option for people with pre-existing health conditions until they are eligible to purchase insurance through the new state exchanges in 2014, with much of their costs subsidized. However, the program's high costs and relatively low enrollment numbers indicate that high-risk pools, which are designed to cover people excluded from the individual insurance market because of a health problem, are not a tenable long-term solution.
Until the exchanges are implemented in 2014 and people can no longer be denied coverage because of their health history, people with pre-existing conditions who are unable to buy coverage have two alternatives for purchasing health insurance—the federal Pre-Existing Condition Insurance Plan, which is administered either by individual states or the federal government, or a state-based high-risk pool if they live in one of the 35 states that offers them. Launched between July and October 2010, the Pre-Existing Condition Insurance Plan has enrolled almost 78,000 people to date, and nearly 226,000 people are enrolled in state-run high-risk pools, some of which have existed since the 1970s. These pools are necessary because people with pre-existing conditions are often unable to purchase health insurance on the individual market, as insurers either charge unaffordable rates, offer plans that don't cover certain health conditions, or deny coverage regardless of ability to pay.
"The health insurance marketplace has failed people with pre-existing conditions for years," said Jean Hall, associate research professor at the University of Kansas and lead author of the new report, The Affordable Care Act's Pre-Existing Condition Insurance Plan: Enrollment, Costs, and Lessons for Health Reform. "Looking at the relatively new federal Pre-Existing Condition Insurance Plan and state-run high-risk pools across the country allows us a diverse view of how these work, and the findings are clear: high-risk pools work as a stop-gap measure, but they are expensive to run, often unaffordable for those who need them, and not a viable long-term solution to the problem of high rates of uninsured Americans."
High-Risk Pool Experiences
The report finds pronounced differences in how each program is structured and in the composition of enrollment. The federal Pre-Existing Condition Insurance Plan is designed to offer immediate coverage to uninsured people with serious health conditions; thus, there is no waiting period for coverage, people can enroll at any time during the year, and premiums do not exceed the current market cost for a healthy individual. In contrast, state-based high-risk pools are somewhat harder to access, as they often have waiting periods and premiums that are as much as 200 percent of the average paid in the local individual market.
Both the federal and state high-risk pools operate at a loss. That is because enrollees are sicker and the premiums paid are not enough to cover their medical costs, requiring significant subsidies to keep the programs running. However, the federal Pre-Existing Condition Insurance Plan appears to be attracting people with higher-cost conditions, like cancer, resulting in per-member monthly costs that are up to nine times higher than those in state high-risk pools. The report's authors note that the federal Pre-Existing Condition Insurance Plan's continuously open enrollment, together with a provision requiring any enrollee to have been uninsured for at least six months, may have led to a generally sicker pool of enrollees with pent-up, high-cost health care needs.
The report finds that the Pre-Existing Condition Insurance Plan is filling a needed role for older adults on the brink of Medicare eligibility. Rates of enrollment are high among people ages 58 to 62, who are sometimes unable to get health insurance otherwise. Young women with high-risk pregnancies are also enrolling in the program; previously, those pregnancies would have been considered pre-existing conditions by carriers in most individual insurance markets across states.
Still Unaffordable for Many
According to the report, an estimated 11.6 million uninsured Americans meet the criteria for high-risk pools, but enrollment is only a fraction of that, indicating that premiums may be prohibitively expensive. Enrollees in the federal Pre-Existing Condition Insurance Plan pay market rates that are in line with what healthy individuals would be charged to buy individual health insurance plans. However, these rates—ranging from a low of $222 a month for the high-deductible plan in Virginia, to a high of $1,215 a month for a plan with a $1,500 deductible in Alaska for a 50-year-old—are often unaffordable to millions of Americans with pre-existing conditions who may make too much money to qualify for Medicaid, do not have health insurance through an employer or spouse, or are not old enough to qualify for Medicare.
The Pre-Existing Condition Insurance Plan does not subsidize premiums, and only a few state high-risk pools offer premium support for those with low incomes. However, once the insurance exchanges are up and running in 2014, premiums will become more affordable, as subsidies will be offered to people with annual family incomes below $92,200 for a family of four.
"Getting sick should not render you uninsurable, but up until the passage of the Affordable Care Act that is exactly what happened," said Commonwealth Fund President Karen Davis. "High-risk pools, while helping thousands of people as a short-term solution, will not guarantee the affordable and secure health insurance coverage and health care that people with illnesses like cancer desperately need. Starting in 2014, nobody will be denied coverage because of a health problem, and premiums will be affordable for all."
Moving Forward
The Commonwealth Fund report finds that despite varied approaches to running high-risk pools, the outcomes are essentially the same: enrollment is low, and enrollment costs and plan operation costs are high, demonstrating the limited viability of these pools as a long-term solution. In contrast, the subsidized health plans that will be offered through health insurance exchanges created under the Affordable Care Act, the law's substantial expansion in eligibility for Medicaid, and new rules that prevent insurers from charging people more or limiting or denying coverage based on health will create pools large enough to offset and absorb enrollees' health care costs while also providing comprehensive, affordable, and secure health insurance coverage. "In short, the only way to make insurance affordable for everyone," the authors say, "is to make sure that everyone has insurance."
More information: The report will be available on September 13th, 2012 at: www.commonwealthfu… ce-Plan.aspx
Provided by
Commonwealth Fund
-
30 million women to benefit from health reform law
Jul 30, 2010 |
not rated yet |
0
-
Health overhaul centerpiece endures growing pains
Oct 03, 2010 |
not rated yet |
0
-
Few small employers likely to opt out of health reform rules
Feb 08, 2012 |
not rated yet |
0
-
Fate of 'uninsurables' hinges on Supreme Court
May 17, 2012 |
not rated yet |
0
-
New report on health reform implementation: How to ensure access to coverage is maintained
May 19, 2011 |
not rated yet |
0
-
Motion perception revisited: High Phi effect challenges established motion perception assumptions
Apr 23, 2013 |
3 / 5 (2) |
2
-
Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update)
Apr 02, 2013 |
4.5 / 5 (11) |
5
-
The visual system as economist: Neural resource allocation in visual adaptation
Mar 30, 2013 |
5 / 5 (2) |
9
-
Separate lives: Neuronal and organismal lifespans decoupled
Mar 27, 2013 |
4.9 / 5 (8) |
0
-
Sizing things up: The evolutionary neurobiology of scale invariance
Feb 28, 2013 |
4.8 / 5 (10) |
14
-
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011
- More from Physics Forums - Independent Research
More news stories
Most elite athletes believe doping substances are effective in improving performance
Most elite athletes consider doping substances "are effective" in improving performance, while recognising that they constitute cheating, can endanger health and entail the obvious risk of sanction. At the same time, the ...
Health
14 minutes ago |
not rated yet |
0
New rice contamination reported in China
Authorities are investigating rice mills in southern China following tests that found almost half of the staple grain in one of the country's largest cities was contaminated with a toxic metal.
Health
3 hours ago |
5 / 5 (1) |
0
Warning images for cigarette packs do not make a strong enough emotional impact
The warning images Brussels proposes to include on tobacco packages in order to reduce consumption do not make the desired impact on smokers because they only find some of them really unpleasant. So, if the ...
Health
4 hours ago |
not rated yet |
0
Cancer and birth defects in Iraq: The nuclear legacy
Ten years after the Iraq war of 2003 a team of scientists based in Mosul, northern Iraq, have detected high levels of uranium contamination in soil samples at three sites in the province of Nineveh which, coupled with dramatically ...
Health
4 hours ago |
not rated yet |
0
Dirty jokes the best medicine
When it comes to men's sexual health, dirty jokes may just be the best medicine. A QUT researcher is helping Family Planning Queensland (FPQ) use comedy and YouTube to deliver sexuality education to young ...
Health
5 hours ago |
not rated yet |
0
Insight into the dazzling impact of insulin in cells
Australian scientists have charted the path of insulin action in cells in precise detail like never before. This provides a comprehensive blueprint for understanding what goes wrong in diabetes.
Estimates reveal low population immunity to new bird flu virus H7N9 in humans
The level of immunity to the recently circulating H7N9 influenza virus in an urban and rural population in Vietnam is very low, according to the first population level study to examine human immunity to the virus, which was ...
Finding a family for a pair of orphan receptors in the brain
Researchers at Emory University have identified a protein that stimulates a pair of "orphan receptors" found in the brain, solving a long-standing biological puzzle and possibly leading to future treatments for neurological ...
Common food supplement fights degenerative brain disorders
Widely available in pharmacies and health stores, phosphatidylserine is a natural food supplement produced from beef, oysters, and soy. Proven to improve cognition and slow memory loss, it's a popular treatment for older ...
Study finds vitamin C can kill drug-resistant TB (w/ video)
In a striking, unexpected discovery, researchers at Albert Einstein College of Medicine of Yeshiva University have determined that vitamin C kills drug-resistant tuberculosis (TB) bacteria in laboratory culture. The finding ...
Glaucoma drug can cause droopy eyelids
Prostaglandin analogues (PGAs), drugs which lower intraocular pressure, are often the first line of treatment for people with glaucoma, but their use is not without risks. PGAs have long been associated with blurred vision, ...