Realizing Health Reform’s Potential The Affordable Care Act’s Pre-Existing Condition Insurance Plan: Enrollment, Costs, and Lessons for Reform

Abstract

The Pre-Existing Condition Insurance Plan (PCIP) is the temporary, federal

high-risk pool created under the Affordable Care Act to provide coverage to uninsured

individuals with preexisting conditions until 2014, when exchange coverage becomes avail- able to them. Nearly 78,000 people have enrolled since the program was implemented

two years ago. This issue brief compares the PCIP with state-based high-risk pools that

existed prior to the Affordable Care Act and considers programmatic differences that may

have resulted in lower-than-anticipated enrollment and higher-than-anticipated costs for

the PCIP. PCIP coverage, like state high-risk pool coverage, likely remains unaffordable

to most lower-income individuals with preexisting conditions, but provides much needed

access to care for those able to afford it. Operational costs of these programs are also quite

high, making them less than optimal as a means of broader coverage expansion.