Evaluation of the Pre-Existing Condition Insurance Plans under the Affordable Care Act

The new health reform legislation includes a transitional national high-risk pool that will go into effect during the first year. It will provide basic coverage for people turned down in the individual insurance market because of health problems. Because insurance coverage offered through the pool will closely resemble the lowest benefit tier of coverage available through the exchanges, it will act as an indicator for the adequacy of benefits, especially for people in poor health. However, little is known about how the program will be administered, who will be eligible to enroll, how much it will cost enrollees and taxpayers, and whether the coverage will meet enrollees’ needs. 

Under the direction of Jean Hall, Ph.D., associate research professor at the University of Kansas Center for Research on Learning, the project team will rapidly produce a brief describing the high-risk pool provisions of the health reform law, identify key implementation and cost issues, and develop recommendations for improvements. The team will also prepare a report on the adequacy of the high-risk pool benefit package and enrollees’ potential cost exposure, and implications for people who enroll in the most basic level of coverage that will eventually be offered through the insurance exchanges. 


Findings from the analysis will provide guidance to policymakers and officials charged with implementation of the national high-risk pool, including options for improving the program that will also be relevant to the implementation of insurance exchanges. 


Jean Hall, Principal Investigator 

Jan Moore, research staff 

Sara R. Collins, Jennifer L. Nicholson, The Commonwealth Fund project staff