HHS Secretary Kathleen Sebelius
There's some very
good news from the Department of Health and Human Services today, on the pre-existing condition insurance plan set up by the government in the Affordable Care Act. The program was set up in the law as a precursor to the insurance reforms that are being phased in over the next three years. It has, thus far, underperformed, with few enrollees often paying excessively high premiums. That could be changing.
WASHINGTON -- The government announced Tuesday that it will lower premiums and ease eligibility requirements for its fledgling health insurance program for people shut out from the private health insurance market because of pre-existing conditions. Premiums will fall by as much as 40 percent in some states.
The Pre-Existing Condition Insurance Plan, run by the Department of Health and Human Services in 23 states and by state governments in the rest, offers relatively affordable coverage for people who've been uninsured for at least six months because of conditions like diabetes or heart disease. The plan launched last summer as one of the first components of the health care reform signed into law by President Obama in March 2010....
To boost enrollment, Sebelius said monthly premiums, which vary by age and region, will drop in 17 of the states where HHS runs the program starting in July. In Alabama, Arizona, Delaware, Florida, Kentucky, and Virginia, premiums will plummet by 40 percent. Come July, people older than 55 who enroll in the Virginia PCIP's standard plan will have to pay $297 a month, a steep drop from the current $498 monthly premium.
So far, only 18,000 people have enrolled in the PCIP, despite the millions of Americans who have been denied private insurance because of pre-existing conditions. The ACA outlaws the practice of denying coverage for pre-existing conditions, but that provision of the law won't be enforced until 2014, when the PCIP will cease to exist. Patients then will be able to find plans in the health insurance exchanges set up by the law.
In addition to reducing the premium costs in the states where the HHS operates the program, Sebelius said that they will ease requirements for proof of denial from insurance companies. Patients will be able to provide a doctor's note indicating their condition, and won't have to produce denial letters from insurers. Apparently the states where the federal government doesn't administer the program will determine whether to implement these new guidelines. "Richard Popper, director of the HHS Office of Insurance Programs, noted that the HHS would be 'issuing a guidance letter to all the 27 state-run PCIPs encouraging them to take a look at the premiums that they charge and the benefit packages, as well as the eligibility rules, allowing them to consider making adjustments similar to what we’re doing in the federally-run pool.'"
What can't be changed, unfortunately, is the rule that would-be enrollees have to wait six months while being uninsured before being eligible for enrollment. That was written into the law and can't be changed by regulation. That's a real barrier to new enrollees, and one reason why the program has such relatively low numbers.