PRE-EXISTING CONDITIONS

PREMISE: The health law would help the roughly 700,000 people with pre-existing health conditions, with little or no cost to the rest of the population.

HOW IT’S WORKING: The law included a temporary program for people with pre-existing conditions, known as the Pre-existing Condition Insurance Plan (PCIP). This program - now closed - essentially functioned as a federal high-risk pool.  Sadly, the program was badly mismanaged. Enrollment for the program peaked at about 115,000, at a cost to taxpayers of $5 billion.  The program ran out of money too early and had to refuse new applicants even if they qualified. This program ended entirely on April 30, 2014, four months behind schedule.

  1. The Administration estimated that as many as 129 million Americans could be considered as having a pre-existing condition that would make it difficult to obtain insurance. (HHS press release) That was one of the primary justifications for the health care law, and one of the primary vehicles for helping those with pre-existing conditions was the federal high-risk pool, which has enrolled just 115,000 individuals at its maximum enrollement in February 2013. (CMS data)
  2. Enrollment for the program was cut off early due to cost concerns. (Reuters)
  3. House Energy and Commerce Subcommittee on Health Chairman Joseph Pitts testified that another 40,000 enrollees would have joined the program in 2013 if enrollment had not been cut off. (Bloomberg)
  4. The Congressional Budget Office warned that the law’s allocation of $5 billion would be far too low to fund the high-risk program.  (CBO estimate)
  5. The program required that people with pre-existing conditions go six months without any insurance before becoming eligible.  This means that people who sought coverage before the health law were excluded, unless they dropped their coverage and went uninsured for six months. (HealthCare.gov)
  6. Costs were so high in this program that for many people they were prohibitive.  Even cutting premiums in this program by 40% did not make it more affordable. (Kaiser Health story)
  7. This program was scheduled to end in December 2013, but was extended to April 30, 2014 because of difficulties with the launch of HealthCare.gov, where people with pre-existing conditions (and other people) are now expected to obtain insurance.

PREMISE: The law was supposed to be in large part about regulatory consumer protections (e.g. for youth, women, people with pre-existing conditions or who have Medicaid).

HOW IT’S WORKING: Of the law’s ten significant parts or “Titles,” only the first two deal with consumer protections and the Medicaid expansion.

  1. The most well-known parts of the law account for just 40 pages of a 2,409-page law.
  1. The individual mandate – 18 pages. (Section 1501(b))
  2. The age-26 rule – 1 page. (Section 2741)
  3. Guaranteed issue requirement that insurers offer insurance to everyone regardless of health status - 1 page. (Section 2702)
  4. The Medicaid expansion – 20 pages. (Section 2001)
  1. The remaining 2,369 pages include
  1. the creation of state-wide health exchanges;
  2. massive cuts to Medicare;
  3. the establishment of a 15-member, non-elected bureaucracy – called the Independent Payment Advisory Board – which will decide what treatments get covered; the creation of numerous new entities to expand government’s involvement in creating and monitoring preventative services and basic health care, and new rules and regulations to make services “free” to patients (which means the costs will be built into premiums);
  4. a rule prohibiting physicians from owning hospitals and clinics, even though these are often some of our best quality and most cost effective means of care that patients want;
  5. the “CLASS Act” (“Community Living Assistance Services and Supports”), intended to be a long-term care program, already abandoned by the Obama Administration over its unworkable and unsustainable funding mechanism;
  6. and at least 20 new tax increases. (Text of the law)

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