Feds Pushing Insurance Plan for Preexisting Conditions


A 40% premium cut and simpler enrollment procedures are two changes the federal government is employing to increase enrollment in the Pre-Existing Condition Insurance Plan, Health and Human Services Secretary Kathleen Sebelius announced during a press briefing.

Launched in July 2010 under the Affordable Care Act (ACA), the Pre-Existing Condition Insurance Plan (PCIP) provides an insurance option for people with preexisting conditions who have been denied coverage and have been without insurance for 6 months or more.

To increase awareness for the program, HHS will offer payment for insurance brokers and agents for successfully connecting eligible enrollees with the PCIP program, said Richard Popper, deputy director of insurance programs in the Office of Consumer Information and Insurance Oversight.

Those seeking coverage under the PCIP will no longer have to wait to receive a denial letter from their insurance company to enroll. Instead, they can provide attestation of their condition from their physician, nurse practitioner, or physician assistant. Patients with preexisting conditions still will be required to be without insurance for 6 months before they are eligible for coverage under the plan, said Mr. Popper. He added that HHS does not have the authority to waive the 6-month waiting period under the current health law.

Ms. Sebelius emphasized HHS's priority to increase enrollment in the program.

“It's encouraging to see more people who need health insurance the most getting it, but we know that's not enough,” Ms. Sebelius said.

The measures comply with the ACA provision requiring the PCIP to align premiums and benefits with the private insurance market, Mr. Popper said. However, he said there's still plenty of room for new enrollees.

“We've been enrolling people at an increasing rate, but we know we have the capacity to cover even more people,” Mr. Popper said.

He added that funding for the measures will fall under the original $5 billion set aside for the program through the health reform law, as well as existing member premiums.

Despite original HHS estimates that several hundred thousand people would benefit from the PCIP, 18,313 people were enrolled as of early May.

The PCIP is run by the federal government in 23 states and the District of Columbia; remaining states operate their own programs using funding from the ACA. HHS sent letters to those 27 state programs, encouraging them to consider similar reforms to their programs.

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