Reuters Money

Public opinion on healthcare reform is divided — Gallup says 46 percent of Americans back Republican efforts to repeal the law, 40 percent want it to stand and 14 percent have no opinion.

Some Americans oppose the law on ideological grounds. But the poll numbers also reflect an enthusiasm gap stemming from the simple fact that the most important provisions of the Affordable Care Act (ACA) won’t kick in for another three years — an eternity in our hyperactive political culture.

Pre-existing conditions offer an instructive example. In the current health insurance marketplace, it’s very difficult for people with pre-existing conditions to buy a quality policy at an affordable price. The problem disproportionately affects people over age 50, since so many of them have chronic conditions that lead health insurance companies to turn them down.

A recent report by the Commonwealth Fund found that 15 percent of all Americans age 50 to 64 were uninsured in 2009; their ranks grew by 1.1 million that year, to 8.6 million. Meanwhile, another 9.7 million in this age group had coverage with such high deductibles that they were considered “effectively underinsured.” Starting in 2014, the ACA will get these folks covered through expansion of Medicaid and the creation of new private insurance exchanges.

In the meantime, the ACA put a Band-Aid on the problem by setting aside $5 billion to fund a pre-existing insurance program (PCIP) that operates until the end of 2013, when enrollees will shift to coverage via the new exchanges.

The PCIP gave states the option of using federal dollars to administer their own programs, or to allow the federal government to offer coverage. Twenty-seven states are offering their own plans.

But the PCIP plans barely made a dent last year. Around 8,000 people enrolled nationwide, and most of those were in a handful of big states with very active plans — Pennsylvania, California, Illinois and Ohio.

The weak start was due partly to the short ramp-up time available after the ACA became law, according to Jean Hall, an associate research professor at the University of Kansas who specializes in healthcare. Hall also notes that the plans offered in many states simply weren’t great deals. Premiums sometimes exceeded $1,000 per month, with annual deductibles as high as $5,000. Finally, enrollees must be uninsured for six months prior to coverage in order to be eligible — a rule that further reduced sign-ups.

But noteworthy improvements are being rolled out to PCIPs this year that will make them worth checking out for those struggling to find insurance.

Premiums will be lower in many states. Moreover, the federal program will offer three plan options, two of which feature lower deductibles for prescription coverage. New child-only premium options also are being offered to reduce the cost of covering children with pre-existing condition.

“I do believe the new federal options represent a significant change for consumers,” Hall says. “People can get prescription costs covered sooner, which is potentially very important for many people with chronic conditions. Also, adding the child-only premiums creates a significant savings for families who have children with chronic conditions.”

The federal website for the ACA has a page that describes the state plans, and lists contact information where consumers can get current information on 2011 insurance options.