Before the Patient Protection and Affordable Care Act of 2010 (ACA), individuals with pre-existing conditions attempting to purchase coverage in the private individual market could be denied coverage, offered coverage at a higher-than-average premium, or offered coverage excluding care related to the pre-existing condition. As a result, millions of Americans remain uninsured, do not have access to adequate healthcare, or resort to less appropriate forms of healthcare, such as emergency rooms. As mandated by the ACA, beginning January 1, 2014, insurers in the individual market will be prohibited from denying coverage, increasing premiums, or restricting benefits because of a pre-existing condition. Until 2014, the ACA requires the establishment of a national high risk health insurance pool to provide affordable health insurance coverage to individuals with pre-existing conditions. The Pre-Existing Condition Insurance Plan (PCIP) was established in July 2010 and the enrollment was expected to be high. However, the enrollment has been much lower than expected. The PCIP is viewed as a pilot program of what will occur with the insurance exchanges in 2014. This study examines reasons for the low enrollment through literature review and key informant interviews. The informants were asked questions addressing three topic areas: (1) Reasons for low enrollment; (2) How enrollment may be increased into PCIP; (3) If similar enrollment trends are to be expected with the exchanges in 2014; and (4) Recommendations for 2014. Content analysis of responses to the major topics elicited four major themes: 1) Premiums too high; 2) The six-month rule is too harsh; 3) Lack of awareness; and 4) Lack of funding. Nevertheless, the program was considered a success by all key informants because it did provide 90,000 people insurance and access to care. Further study will be needed to track the impact on this population once the new mandate begins.
Presentation: 30 minutes
Recommended CitationBassi, JD, Preet K., "The Low Enrollment into the Affordable Care Act's Pre-Existing Condition Insurance Plan" (2012). Master of Public Health Thesis and Capstone Presentations. Presentation 68.