GAO Drops In To See What Condition ObamaCare's Pre-Existing Condition Plans Are In


ObamaCare's high-risk pools were supposed to provide a bridge from the law's 2010 passage through the implementation of new, state-run health insurance exchanges in 2014. Those high-risk pools, which would accept anyone who could demonstrate they'd been uninsured for six months, were designed to offer immediate coverage to people who might otherwise have difficulty obtaining health insurance because of "pre-existing conditions." The plans were given a name to reflect this: PCIPs, for Pre-Existing Condition Insurance Plans.

What does the current state of those plans tell us about the problem of pre-existing conditions? 

PCIPs abide.

The initial worry, which I shared, was that the program would fill up rapidly, with a strong likelihood that demand would outpace the program's ability to comply: In the summer of 2010, the Department of Health and Human Services estimated that the program would provide health insurance coverage to about 315,000 people through 2013. Others worried that the flood of people into the program would be even larger. Medicare's own chief actuary warned that excessive demand could cause the program, intended to last through 2014, to run out of money within a year.

By February of 2011, however, the program had just a shade over 12,000 enrollees. A big state like California had a mere 706 enrollees. North Dakota had only five. Maine had 13, which, by June, had inched up to…14. The most recent figures indicate the program has just a little over 21,000 emrollees, and that's after HHS went out of its way to draw more people into the program by lowering premiums

What happened? A new report from the Government Accountability Office rehearses a number of explanations: The requirement that enrollees be uninsured for a full six months before appyling; "affordability concerns" about the program's premiums; a lack of public awareness about the program; conflicts with existing state high-risk pools; other eligibility concerns. Some of these factors likely played a role—the six month requirement seems likely to be the biggest offender. But it still doesn't explain why the estimates were so far off. After all, it's not as if all of these factors were entirely unknown before the program's launch.

When the first set of low numbers were revealed, John Goodman, a health policy expert and president of the National Center for Policy Analysis, suggested that perhaps the figures were low because there simply weren't that many people whose preexisting conditions had kept them out of the system in the first place:

Alert readers will remember the White House summer of 2009 invitation to all Americans to send in their horror stories describing health insurance industry abuses. Although the complaints were many, the vast majority were about pre-existing condition limitations. Then, on the eve of the ObamaCare vote, every member of Congress who appeared on television to defend the legislation was able to cite by name an individual or family in his or her state or Congressional district with a heart wrenching story.

…While a lot of people are surprised by these numbers, I am not. Here is why. Don't you think it is a bit odd for the White House to send out an appeal to victims so they can identify themselves? That's not normally how the political system works.

The more usual scenario is: victims unite and form interest groups; they lobby Congress, write letters, testify, etc; and eventually the pressure become so great that Congress legislates.

When have you ever heard of that entire process in reverse? When has Congress ever before decided it wants to do something and then conducted a nationwide search to find people who will benefit?

The reasons for the reversal is that this whole problem has been completely hyped and exaggerated from the get go. In this country we have made it increasingly easy for people to get health insurance after they get sick. Going to work for an employer with generous health benefits, for example, is the most direct way.

Of course that system will miss people who are too sick to work. And that may explain why the few who are signing up appear to have very high medical expenses.

The six-months-uninsured requirement was designed to help ensure that the program was limited to those who were genuinely, unusually hard to insure. Perhaps it worked?

NEXT: For Pete's Sake, Go Get Your Kids Vaccinated Already!

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  1. Great, next you are going to tell us there are only like 6 senior citizens who ate dog food so they could afford their medication.

    1. That’s six too many. I don’t care if two of them ate it even before they got old.

    2. Dog food isn’t that cheap.

  2. Offtopic:

    Next Ron Paul money bomb is 9/17 (Constitution Day).

    Pledge at RonPaulWins dot com.
    Donate at RonPaul2012 dot com.

    1. I missed the last one, so I’m in.

      1. My money and I will soon part.

  3. “Politics is the art of looking for trouble, finding it whether it exists or not, diagnosing it incorrectly, and applying the wrong remedy.”
    –Sir Ernest John Pickstone Benn

  4. When the first set of low numbers were revealed, John Goodman, a health policy expert and president of the National Center for Policy Analysis, suggested that the chinaman was not the issue.

  5. What’s with all the really long articles the past couple days? It’s Friday, can’t we have a break?

    1. Fridays should be limited to articles on beer and high res photos of Lobster Girl.

      1. Need a gamer thread.

        Any played Deus Ex yet? I have my copy, but I’m still working Dragon Age II.

        1. PC or console?

        2. I’m strongly considering picking up a copy on the way home tonight, just to have something to play during the hurricane.

        3. Fucked up priorities, man. Drop DA2: Invisible War and get augmented.

      2. Now if a post about beer and Lobster Girl managed to work in a Big Lebowski reference, THAT would be a Friday afternoon gift from the gods.

  6. Yeah, yeah, oh-yeah
    What condition my condition was in

    1. That’s the only line to that song that I know, and you’ve got it stuck in my head.


  7. ObamaCare has helped all the constipated democrats shit the republicans out of office

  8. The high-risk pool really tied the law together, did it not?

    1. What happened to your pool, dude?

      1. Shut the fuck up, Mr. Simple.

  9. pls leave the dude, & walter outta it

    1. I don’t really give a shit about this post (I already know Obamacare sucks so I don’t care about the details) but I was hoping for a full-on Lebowski comment thread. So far it’s been a bit of a disappointment, much like the Eagles (who I fucking hate).

      1. So far it’s been a bit of a disappointment, much like the Eagles (who I fucking hate).

        Conosidering that the Philadelphia Eagles have looked fairly disappointing compared with the hype they received prior to the preseason starting, I am assuming that you were talking about them. Although, obviously, the Big Lebowski the dude references hating the Eagles, the band, and therefore this particular phrase is laden with pun that I thoroughly appreciated.

        1. Eagles are football’s Heat.

  10. …While a lot of people are surprised by these numbers, I am not. Here is why. Don’t you think it is a bit odd for the White House to send out an appeal to victims so they can identify themselves? That’s not normally how the political system works.

    This is not true. The political system will often create a program for ‘underserved’ people, then complain bitterly that there aren’t enough people enrolled, then go on an all-out public appeal to get more people into the program.

    1. No kidding. Many hospitals have actual state employees permanently on-site to interview patients and sign them up for every welfare program they can.

      Its SOP.

    2. I remember an article here a while ago about California’s food stamp program (whatever they call it–CalFresh or something like that). At one point there were fewer enrollees than expected. Rather than actually spend less than planned (we all know what kind of deficit they have) or express gratitude that some people are actually able to provide for themselves, program officials searched high and low for more people to sign up.

      God forbid some people are actually not dependent on government for everything.

  11. Mr. Obama draws a lot of water in this town. You don’t draw shit, Suderman. Now we got a nice, powerful little federal government here, and I aim to keep it nice and powerful. So let me make something plain. I don’t like you sucking around, bothering our Congressman, Suderman. I don’t like your jerk-off name. I don’t like your jerk-off face. I don’t like your jerk-off articles, and I don’t like you, jerk-off. Do I make myself clear?

    1. I’m sorry, I wasn’t listening.

  12. That’s so weird! I totally saw the Big Lebowski yesterday.

  13. LOL, sounds like those guys are smoking some serious crack!


Please to post comments

Comments are closed.