Obamacare's Biggest Winners Also Have the Most to Lose

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Before the Affordable Care Act, sick people with pre-existing conditions did have some access to insurance, through state-run high-risk insurance pools. As ProPublica explains on Friday, many of those programs are closing on December 31, which means people will need to sign up for insurance through a functioning federal or a state-run exchange. The Obama administration has promised that Healthcare.gov will work smoothly by November 30, which gives shoppers a little more than two weeks to enroll in coverage effective January 1. 

There are insurance programs for people with pre-existing conditions?

Yes. Obviously, people with pre-existing conditions have been denied coverage and dropped from plans prior to Obamacare, but there were state-run programs that provided temporary coverage to high-risk individuals who had been uninsured for at least six months. The rules varied, but Oklahoma's high-risk pool has a lifetime benefit maximum of $1 million and California's high risk pool capped lifetime benefits at $750,000, and annual benefits at $75,000. 

Then there's the federal and state-run (in 10 states) Pre-existing Condition Insurance Plan, created by Obamacare to tide people over until next January. Like state high-risk pools, the program accepted individuals with pre-existing conditions who had gone six months without health insurance (including a limited benefit plan). These plans will end when Obamacare insurance kicks in on January 1. 

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So what are people supposed to do?

For the most part, get insured by January 1. To be insured by January 1, you have to be enrolled in a plan by December 15. That means you've picked a plan that meets your needs, you've completed an application, your income and subsidies have been verified and you've paid your first month's premium. It also means the exchange hasn't sent your insurer the wrong information. It's not a process you want to put off until the last minute, especially when you can't afford to go a month without insurance. One Oklahoma woman told the Associated Press her cancer treatment would cost her $500,000 without insurance (though she didn't say over how long a period).

How serious is this?

Things get a little more serious every day the federal exchange isn't working. The Pre-existing Condition Insurance Plan ends on December 31, but most of the state high-risk pools will stay open until after January 1. As of June 2013, according to the National Association of State Comprehensive Health Insurance Plans, of the 35 states with high-risk pools, 15 states have confirmed that they will shutter their pools on December 31 or January 1. The other states are either undecided, or plan to continue coverage into early or late 2014. Of the 15 states ending coverage at the end of next month, Kentucky has a functional state-run exchange.

That leaves residents in 14 states in a potentially precarious situation. Aware of the situation their residents are in, a few of those states extended their risk pools. Indianians will have until the end of January 2014 to enroll through the exchange, and Oregon is working on a contingency plan, since no one has enrolled through Covered Oregon.

And while it may work out that the federal and state-run exchanges are all working perfectly on November 30, there's no accounting for stress. "Even if the technology was really perfect, it would still be hard to sign up because many people who are really sick don't respond well to change," Linda Nilsen Solares, executive director of Portland's Project Access NOW for the uninsured, told the Associated Press. "Many of them are just trying to get through the day."

(Map by National Association of State Comprehensive Insurance Plans.)

This article is from the archive of our partner The Wire.