One of the things Americans like most about the Affordable Care Act is that insurance companies can no longer deny people coverage because of a pre-existing condition like cancer or diabetes. That provision will take effect in 2014, but in the meantime, individuals and families with pre-existing conditions can enroll in temporary high-risk insurance pools that provide coverage for those who are can’t find insurance elsewhere.

Since large groups of sick people are very expensive to insure — they spend the premiums they pay into the risk pool — enrollment has lagged behind expectations, as high risk pools attracted the sickest (and more desperate) individuals willing to pay a hefty price for coverage. But since the federal government instituted a series of reforms, enrollment has picked up. In Alabama, for instance, the size of the state’s pool increased six-fold over the last year, when premiums were cut by 40 percent. Other states also saw tens of thousands more Americans join their state’s pools:

The U.S. Department of Health and Human Services reports that as of the end of February, 389 people in Alabama were on the special insurance, an option for people with illnesses that make them a high risk, such as cancer or diabetes. Last February, there were 61 enrollees. [...]

Alabama’s uptick in enrollment follows a national trend over the last 12 months, when enrollment grew from 12,437 to 56,257. The plans are for people who have been denied coverage because of their health status and are struggling to find affordable insurance. To qualify, people must have gone without health insurance for six months and not be eligible for Medicaid or Medicare.

“For too long, Americans with pre-existing conditions were locked out of the health care system, and their health suffered,” HHS Secretary Kathleen Sebelius said in a recent prepared statement. “Thanks to health reform, our most vulnerable Americans across the country have the care they need.”

Alabama is far from alone in seeing higher enrollment. According to the National Conference of State Legislatures, 49 states, plus Washington, DC, saw an increase in enrollment in their high-risk pools last year. (The lone outlier, Vermont, was not listed as having any enrollees in its pool, but is a “guaranteed issue state” which offers policies to all eligible applicants regardless of their health.) The federal government’s contribution to the program — $5 billion — is running out fact, but given the new enrollment numbers, the law is clearly having an impact.

-Zachary Bernstein

The Affordable Care Act’s Pre-Existing Condition Insurance Plan (PCIP) is credited with providing comprehensive health coverage to nearly 50,000 Americans with high-risk pre-existing conditions, according to a report released today by the Department of Health and Human Services. The PCIP is a temporary program intended to make health coverage available and more affordable for individuals who are uninsured — and were likely denied coverage based on their pre-existing conditions — and are ineligible to receive Medicare and Medicaid. Once the health reform law is fully implemented, in 2014, insurers will be prohibited from refusing coverage to any American with a pre-existing condition.

Since its launch in November 2010, there has been an approximate 400 percent increase in PCIP enrollment — specifically amongst older uninsured Americans, who’s serious pre-existing conditions require more intensive and ongoing medical care — with the PCIP program attracting 8,000 new applications every month from August through November 2011.

PCIP enrollees are immediately granted access to the most basic medical treatments, including primary and specialty care, hospital care, prescription drugs, home health and hospice care, skilled nursing care, preventive health and maternity care, but because of the severity of many of the enrollees’ conditions, 78 percent of the total cost to run the program is spent on providing care for four types of potentially life-threatening medical needs, such as: cancer, circulatory diseases (i.e. coronary artery disease), degenerative joint diseases, and rehabilitative care/aftercare (i.e. radiation and chemotherapy).

In 2011 the Federally-administered PCIP served 628 enrollees with cancer, including 333 enrollees diagnosed with breast cancer, and covered more than 1,000 enrollees with a diagnosis of either ischemic heart disease or heart failure. Assuming that the risk profile of the Federally-administered PCIP population is reflective of the program as a whole, we estimate that the PCIP program served nearly 1,900 individuals with cancer and approximately 4,700 people with heart disease in 2011.

A recent study examined a sample of 1,485 enrollees in 10 state-based PCIPs and found that 18.7 percent of individuals had joint disease, 16.8 percent of individuals had diabetes or other disorders of the endocrine system, and 15.4 percent had cardiovascular disorders. The top five diagnoses or procedures by cost vary by State, but typically include cancers, ischemic heart.

Some states have had trouble getting the high risk pools off the ground and have either relied on existing state programs or offered patchy benefit packages“. The transition to the new pools has been less than flowing, with enrollment failing to meet the Obama administration’s projections, and while most states still have yet to exceed their operating budgets, at least nine have burned through their money and are currently requesting additional funding — Alaska has spent $13 million on just 45 people. Costs have also stunted enrollment rates, as premiums remain impossibly high, even after the federal government’s decision to reduce them in an attempt to appeal to more people.

– Fatima Najiy

Our guest blogger is Emily Oshima, a Research Associate/Policy Analyst with the Health Policy team at American Progress.

Although Newt Gingrich once publicly championed the individual health insurance mandate, he – and other Republicans – now staunchly oppose the idea. During a town hall in Davenport, Iowa on Monday, the former House Speaker argued that while the mandate can prevent healthy people from free riding the health care system, the provision forces “politicians” to “define health care.” Instead, he endorsed economist John Goodman’s “patient power” solution, which uses tax credits to encourage healthier and younger people to purchase insurance before they become sick and shift the costs of their care throughout the health care system. Under Goodman’s proposal, Americans who go uninsured would store away the credit they would have received for purchasing coverage to later spend on “charity care” -– essentially the high risk pools Republicans proposed as an alternative to the Affordable Care Act.

But Gingrich once supported the mandate for a reason. The mandate is the only mechanism that will move America towards universal coverage and ensure that all people have access to quality care. The Congressional Budget Office (CBO) estimates that eliminating the mandate would reduce coverage by 16 million people. Even generous premium credits –- which likely go beyond what’s included in the Goodman plan — would cover only 40 to 50 percent of the uninsured.

The high-risk pools are no more effective. Since covering large groups of sick people is expensive, the CBO found that Republican high risk pools would cover fewer than 3 million patients, while significantly driving up premiums for all by redistributing the high health care costs of some users more broadly. The Affordable Care Act’s temporary pools have encountered similar cost problems. Further, high risk pools require government funding — given recent attempts to slash Medicaid and states’ tight budgets, can we really believe that Gingrich is committed to funding care for “charity”?

What’s more, there are numerous flaws with the structure of his proposed tax credits: They are inadequate –- keeping insurance prohibitively expensive for some –- and would fail to grow with rising costs. Without the regulatory protections of the ACA, Goodman’s plan would also throw millions of people into “the Wild West” of the individual health insurance market, where millions of Americans will be denied or priced out of coverage altogether.

Yesterday, ThinkProgress brought you the tragic story of Kent Snyder, Rep. Ron Paul’s (R-TX) 2008 presidential campaign manager. Snyder, who was the person that convinced Paul to run for the White House, died that same year at 49 from pneumonia because he lacked health insurance. His story is getting renewed attention in light of Paul’s exchange with moderator Wolf Blitzer at CNN’s debate Monday night, in which he was asked what should happen to a comatose 30-year-old man who lacked insurance — someone similar to Snyder. When Blizter asked if the hypothetical patient should be left to die, some members of the audience yelled “yes!”

Now, CNN reports that Snyder lacked insurance because he had a pre-existing medical condition, which “made it impossible for him to find coverage.” Watch the segment from last night’s Situation Room:

There are an estimated 50 to 129 million Americans who, like Snyder, have medical conditions that lead to higher health insurance costs or an inability to find any coverage at all. sSolving this problem is one of the core goals of President Obama’s Affordable Care Act.

By 2014, the law will forbid insurers from charging sick patients more or rejecting them out of hand, a move that is only possible when coupled with the individual health insurance mandate conservatives despise. But even before 2014, Snyder could potentially have been eligible for a federal high-risk insurance pool for people with pre-existing conditions, which was established last year.

People like Snyder, who cannot find affordable insurance, are exactly who the law is intended to help. Even people who hate the law, like Paul — who has said “Obamacare” is “monstrous” and “bad for your health” — may find themselves thankful for it down the road.

I’ve recently been told that liberal groups and blogs are eager to pounce on the administration for not living up to certain progressive principles but rarely highlight instances of accomplishment. And so, it’s in an effort to correct the imbalance that I point to the government’s efforts to reduce health care premiums in the federally-run, high-risk insurance pools — temporary coverage programs for uninsured people who can’t find coverage in the individual market — and encourage more uninsured Americans to sign up:

Uninsured sick people got some good news recently, or some of them did, anyway. Starting July 1, the Obama administration reduced the premiums by up to 40 percent in special high-risk insurance plans that the federal government is running in 17 states and the District. [...]

On the low end, Mississippi will reduce premiums by 2 percent. Several states will cut monthly rates in the 15 to 25 percent range, including the District , which will reduce premiums by 18 percent. Six states, including Virginia, will reduce their premiums by 40 percent.

The change means that a 55-year-old District resident who would have owed $551 per month under the old rates for the standard plan will now owe $450. In Virginia, the same person’s premium would now be $297 monthly, compared with $498 before.

The premium rates in the 23 states where the federal government runs risk pools will now more closely resemble the “rates for individual policies in each state,” which, while lower than what those pools had been charging, are still prohibitive for many of the individuals who would quality for coverage.

Still, a recent report from the Commonwealth Foundation found that high premiums aren’t solely responsible for pools’ relatively low enrollment rates. “[P]eople with preexisting conditions who have been uninsured for a long time may have stopped looking” for coverage, the government has conducted limited outreach efforts (due to the relatively fast implmentation schedule), and given the multiple court challenges to reform and the media’s taste for covering negative verdicts, Americans may simply be confused about the status of the law, the report found.

The Commonwealth Fund is out with a new report examining why enrollment trends in the Affordable Care Act’s high risk insurance pools — temporary coverage programs for uninsured people who can’t find coverage in the individual market — have generally fallen below expectations. Besides the obvious structural challenges, Jean P. Hall and Janice Moore also suggest that the GOP’s efforts to repeal the law may already be undermining the high risk insurance program:

– SHORT IMPLEMENTATION PERIOD: “Given the short implementation timeline, PCIP administrators did not have ample resources available to conduct extensive outreach at the outset of the program.”

– UNINSURED HAVE STOPPED LOOKING: “[P]eople with preexisting conditions who have been uninsured for a long time may have stopped looking for insurance and may therefore be harder to reach via traditional outreach campaigns.”

– UNAFFORDABLE: “Because the PCIP coverage is based on the individual insurance market, premiums and out-of-pocket costs are generally higher than for people enrolled in group insurance plans.”

– MISCONCEPTIONS ABOUT THE LAW: “In late 2010, for example, many heated election campaigns were declaring that health reform would soon be repealed and/or replaced, or at least de-funded…. Indeed, a February 2011 poll by the Kaiser Family Foundation found that almost one-quarter of the American public believed that the Affordable Care Act had been repealed, while another quarter did not know the status of the law.”

Enrollment finally topped 20,000 in April and is expected to increase in the months ahead. Recently, the Department of Health and Human Services “announced that it would lower premiums in the 23 states where high-risk pools are operated by HHS. The remaining 27 sates run their own plans.”

This morning, the Department of Health and Human Services released a new report showing that up to 129 million Americans have a pre-existing condition and would likely be denied coverage in the individual health insurance market. During an appearance this morning on MSNBC, Secretary Kathleen Sebelius admitted that most of these individuals already have coverage, but argued that they would have a hard time finding insurance if the law were repealed and they were to lose their job. “A number of people are in jobs with large employers where people can’t be underwritten because of their health condition, that’s good news. But those folks frankly can’t look at leaving that jobs, can’t start their own business, can’t have the freedom to retiring early before they have qualify for Medicare because they are terrified they will lose that insurance coverage,” Sebelius said, pointing out that insurers deny coverage to 1 out of every 7 who apply for it in the individual market.

House Rules Committee Chairman Rep. David Dreier (R-CA) dismissed these concerns while responding to the report on Fox News, but apart from questioning the timing of the release of the study, Dreier didn’t challenge the report’s conclusion or provide a clear explanation for how Republicans would help the 129 million Americans find access to affordable insurance:

DREIER: I think that if you look at policy providers they’re saying that many of those people who fall into that category are already insured and it’s very interesting, very interesting that that study has come out literally the day that we begin the debate on this issue. We all want to ensure that people with pre-existing conditions have their needs addressed and I think we can find effective ways to do just that.

Watch it:

Republicans have suggested that they would cover sicker Americans in high-risk insurance pools, which are already part of the existing legislation and are designed to provide insurance to the sickest Americans before the exchanges become operational in 2014. Unfortunately, the high premiums associated with covering only sick people has kept these programs out of reach for most of the eligible population.

In fact, Republicans — who have long championed the pools as a means of extending coverage to those who don’t qualify for insurance in the individual market — have criticized the programs as ineffective and underfunded. The ACA provides $5 billion to run the temporary pools for three and a half years while the Republicans have proposed spending $25 billion over 10 years to keep the pools running on a permanent basis.

The Department of Health and Human Services (HHS) announced new plan options and lower premiums in the 24 high risk insurance pools that are under federal control in an effort to bolster enrollment in the fledgling program. The so-called Pre-Existing Condition Insurance Plan (PCIP) functions as a bridge to the Affordable Care Act’s exchanges for people who can’t find affordable coverage in the individual market, but thus far, the program’s high premiums have kept many eligible individuals from enrolling. The program currently boasts just 8,011 beneficiaries.

Starting January 1, however, Americans enrolled in a federally-run PCIP program, will have two new coverage options: a plan with a $1,000 deductible and $250 deductible for prescriptions, a $2,000 deductible with $500 deductible for prescriptions and the exiting option of a combined medical and prescription drug deductible of $2,500, which will be paired with a federal health savings account.

“Adjustment in rates in existing and new premiums will be nearly 20 percent below what is currently being charged today, ” Richard Popper, Director for the Office of Insurance Programs in HHS’s Office of Consumer Information and Insurance Oversight, a said on a conference call attended by the Wonk Room. He suggested that PCIP enrollment levels are comparable to the early enrollment rates in CHIP and predicted that the program’s “enrollment continue to grow and with the change in premiums we see that trend escalate.”

In working towards that end, the government is also stepping up its outreach and enrollment efforts:

- Working with states in the federally-run pool programs to encourage their state insurance departments to require individual market insurance companies to notify those who may deny coverage about the availability of PCIP.

- Encouraging insurers to notify denied applicants about the PCIP option. A number of insurers have agreed to put notice in their denial letters about availability of PCIP.

- Working with the Social Security Administration to inform individuals under 65, who are not yet eligible for Medicare, about PCIP.

- AARP has sent out notices to their 24 million members about the availability of PCIP.

Some of the 27 states that are operating their own high risk health insurance pools are already offering similar options and all states will have “the opportunity to submit any changes they would like to make in their benefits or premiums for 2011.” “But we are not requiring the states to exactly adopt the changes that we are rolling out,” Popper said. “This program is largely build on state flexibility. With that flexibility and with the available products available we don’t feel the need to require them to copy what’s being done on the federal pool level.”

“We are doing everything we can do get as much enrollment and we’re doing as much outreach and we think premiums will help and hope that other states will follow suite,” Liz Fowler, Director for Policy in HHS’s Office of Consumer Information and Insurance Oversight said on the call.

In July, following GOP allegations that states would be able to use federal dollars to cover none-Hyde abortions in the temporary high risk insurance pool program, HHS issued regulations prohibiting states from covering the procedure. “The (high-risk pool) program,” the regulation states, “is Federally-created, funded, and administered (whether directly or through contract); it is a temporary Federal insurance program in which the risk is borne by the Federal government up to a fixed appropriation. As such, the services covered by the PCIP program shall not include abortion services except in the case of rape or incest, or where the life of the woman would be endangered.”

Progressive pro-choice advocates felt betrayed. Since there is no over-arching law that prevents states from using federal dollars to fund abortion services, the administration was not required to alter the state’s proposals. Writing at RH Reality Check, CAP’s Jessica Arons accused the administration of applying the Stupak amendment to the high risk pools and going beyond the bargain it struck. Now, 19 national pro-choice groups have “signed on to public comment, submitted Monday, urging HHS to ‘revise this rule and remove the ban.’” The group, Raising Women’s Voices has released a video and letter writing campaign, “highlighting stories of women with pre-existing conditions who have had abortions,” urging Sebelius to “lift the harmful abortion restrictions”:

My doctor said my health is at risk. Here is a Catch-22. My insurance will pay for the pregnancy that can seriously injure me, but it won’t cover the abortion that can protect my health. I don’t get it.

Watch it:

It’s unclear if the group can change the rules after it’s been written, but it’s fairly obvious that the pro-choice community was outmaneuvered by the Right. Few realized that Nelson’s amendment did not apply to every federal dollar in the health care law, and the administration seemed unprepared to fight once conservatives organized around the issue. In fact, when I spoke to some state sources who were implementing the pools, they were surprised to learn that the Hyde restrictions did not apply to the federal funds earmarked for the program. But what’s disappointing is that the administration felt so compelled to issue its restrictive regulations so quickly and reactively. If it was hoping to appease conservatives, then it overestimated the GOP’s willingness to recognize its concessions and underestimated its supporters ability to just accept the slight (yet again).

Public comment on the high risk pools closed Tuesday at midnight.