Primer: High-Risk Health Insurance Pools

Efforts to reform the healthcare system focus on expanding coverage and providing continuous access to uninsured Americans.  Currently, concerns about access to insurance coverage are especially pronounced among Americans with pre-existing conditions, such as asthma, diabetes, cancer and heart disease. In the individual market, people with serious pre-existing medical conditions are often denied coverage, or are charged very high monthly premiums, as they are considered by insurance companies to be “high-risk” candidates.

The Affordable Care Act (ACA) addresses this with insurance reforms set to begin in 2014. Guaranteed Issue requirements will prohibit plans from excluding individuals based on pre-existing conditions; similarly, Community Rating will require health insurance providers to offer plans at the same price to everyone, despite health status. The ACA created the Pre-existing Condition Insurance Plan (PCIP) as an attempt to provide temporary coverage for this vulnerable population until the insurance reforms go into effect. However, the PCIP program has delivered unsatisfactory results thus far, since fewer Americans than expected have enrolled.

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