42 U.S.C. § 18001 — Immediate access to insurance for uninsured individuals with a preexisting condition

(a) In general No later than 90 days after March 23, 2010, the Secretary had to set up a temporary high-risk health insurance pool program. This program covered eligible individuals from the day it started until January 1, 2014. (b) Administration (1) The Secretary could run the program directly, or contract it out to other organizations. (2) To get a contract, an organization had to: (A) be a state or a nonprofit private group; (B) submit an application in the form and with the information the Secretary required; and (C) agree to use the contract's funding to set up and run a qualified high-risk pool for eligible individuals. (3) A state that wanted a contract had to promise not to spend less on its own high-risk pool programs than it spent the year before. (c) Qualified high-risk pool (1) Money under this section had to go toward setting up a pool that met the requirements below. (2) A qualifying pool had to: (A) cover all eligible individuals with no exclusion for pre-existing conditions; (B) pay at least 65% of the total allowed cost of covered benefits, and cap out-of-pocket costs at the same limit that applies to health savings accounts under 26 U.S.C. § 223(c)(2) (the Secretary could adjust this cap if needed to keep the 65% actuarial value); (C) set premiums that: (i) vary only the way section 300gg allows; (ii) vary by age by no more than a 4-to-1 ratio; and (iii) use one standard rate for a standard population; and (D) meet any other requirement the Secretary set. (d) Who counts as an eligible individual Someone qualified if they: (1) were a U.S. citizen or national, or lawfully present in the country; (2) had not had "creditable coverage" (as defined in section 300gg(c)(1)) for the 6 months before applying; and (3) had a pre-existing condition, determined the way the Secretary's guidance said. (e) Protecting against insurers dumping risk (1) The Secretary had to set criteria for spotting when an insurer or an employer health plan pushed someone out of their existing coverage because of that person's health. (2) If the Secretary found that an insurer encouraged someone to drop coverage before joining the high-risk pool, that insurer or plan had to reimburse the program for the person's medical costs. The rules covered situations like: an employer or plan paying someone money to drop coverage; an issuer or plan paying someone to drop coverage; or, when someone's old premium was higher than the pool's premium, the old policy no longer being actively sold, or the old policy allowing health status to affect renewal premiums. (3) This isn't the only remedy available — states can still enforce their own laws against insurers doing this. (f) Oversight The Secretary had to set up: (1) a process for people to appeal decisions made under this section; and (2) procedures to prevent waste, fraud, and abuse. (g) Funding and when the program ends (1) Congress appropriated $5,000,000,000, available without a yearly limit, to pay claims and administrative costs that exceeded the premiums collected. (2) If the Secretary expected the money to run short in any year, the Secretary had to make adjustments to close that gap. (3) Coverage under a state's high-risk pool ended on January 1, 2014, except that the Secretary had to create a smooth transition plan moving people from the high-risk pool into qualified health plans on an Exchange, with no gap in coverage — and could extend pool coverage past 2014 if needed to prevent a gap. (4) The Secretary could stop accepting new applications if needed to stay within the funding limit. (5) These rules override conflicting state laws or regulations, except state licensing laws and state laws about an insurer's solvency.