Health Policy Brief: Pre-Existing Condition Coverage
August 10th, 2010
by
Chris Fleming
|
The latest Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation (RWJF) explores challenges facing the new Pre-Existing Condition Insurance Plan, a program designed to help those with illnesses who have had difficulty obtaining affordable health insurance.
The brief reviews decisions that may need to be made by the administration and Congress as the program goes into effect nationwide. Some of the areas covered are:
- Descriptions of the types of temporary high-risk state pools and mechanisms used by states without pools to insure residents with preexisting conditions;
- The costs and benefits to individuals and funding challenges facing the program; and
- How the Department of Health and Human Services may adapt the program as needed: revising the program, moving funds between states, and other mechanisms.
For more on the Pre-Existing Condition Insurance Plan, see the article in the June issue of Health Affairs by Deborah Chollet, as well as Chollet’s presentation at the release event for the issue. See also Health Affairs Blog posts by Timothy Jost and by Thomas Miller and James Capretta.
Background:
As the new brief explains, among the beneficiaries of the Patient Protection and Affordable Care Act are people with illnesses or disabilities who have suffered administrative and financial hurdles obtaining health insurance. Many of these problems will be alleviated in 2014, when the act takes full effect.
Until that time, children with preexisting medical conditions have been guaranteed coverage, and uninsured adults who have preexisting conditions will be eligible for coverage, in special state-based pools starting this month. The amount appropriated by Congress—$5 billion for this interim period—is not considered sufficient to sustain the program through 2013, however, and the Congressional Budget Office estimates that another $5 to $10 billion may be needed.
Because of the limits on funding, there are concerns that during this interim period both the benefits and the number of enrollees may need to be curtailed, or Congress will need to appropriate more funds, or both.
About Health Policy Briefs:
Health Policy Briefs are aimed at policy makers, congressional staffers, and others who need short, jargon-free explanations of health policy basics. The briefs include competing arguments on policy proposals from various sides and the relevant research supporting each perspective.
Previous policy briefs have addressed:
– Accountable Care Organizations (ACOs): What awaits health systems, physicians, administrators, insurers, patients, and policy makers as a result of this year’s health reform legislation?
– Extra Federal Support for Medicaid: The congressional debate on extending the increase in federal assistance to the states and the impact on state budgets.
– Paying physicians for Medicare services: Efforts to forestall a cut in physicians’ fees and revise the Sustained Growth Rate payment formula.
SIGN UP FOR HEALTH POLICY BRIEFS
Health Policy Briefs offer more context than fact sheets but are a quicker read than most backgrounder papers. The information is objective and reviewed by Health Affairs authors and other specialists with years of expertise in health policy.
Sign up for an e-mail alert about upcoming briefs. The briefs are also available from the RWJF’s Web site. Please feel free to forward the briefs to any of your colleagues who are tracking health issues. And after you’ve taken a look, we welcome your feedback at: hpbrief@healthaffairs.org
Email This Post
Print This Post
