Professional Service Agreement

Affordable Care Act — Pre Existing Insurance Plan out of Money Not Accepting Any More Participants

February 22, 2013

One of the primary reasons for national healthcare was to cover the estimated 5 to 25 million citizens who have preexisting conditions and could not get coverage. Now, only after 100,00 signed up for the preexisting pool, the Administration has blocked any new participants, effective immediately, with preexisting conditions.

Obama administration officials said that the state-based "high-risk pools" set up under the 2010 health-care law will be closed to new applicants ( those with preexisting conditions ) no later than March 2, depending on the state. But they stressed that coverage for about 100,000 people, who are now enrolled in the high-risk pools, will not be affected.

The program, which was launched in summer 2010 was supposed to last until 2014. At that point, the health-care law will bar insurers from rejecting or otherwise discriminating against people who are already sick, enabling such people to buy plans through the private market.

From the start, analysts questioned whether the $5 billion that Congress appropriated for the Pre-Existing Condition Insurance Plan — as the program is called — was sufficient.

Of the original $5 billion, about $2.36 billion remains available for the last three quarters of 2013 — enough only to continue coverage for those already in the pools, according to administration estimates.

Obama administration officials said they did not have estimates for how many more people would have sought coverage through the pools for the remainder of this year. However, a spokesman for the Department of Health and Human Service said that new enrollment has averaged about 4,000 people per month in the past several months, suggesting that the figure could number in the tens of thousands.

SESCO will continue to monitor developments under the ACA. Contact SESCO should you have any questions or would like to purchase our manual: An Employer's Guide to Healthcare Reform. You may also purchase on line by clicking HERE.