Obama administration extends state high-risk pools through January

December 12, 2013
(Photo by Mike Segar /Reuters)
(Photo by Mike Segar /Reuters)

With some high-risk patients still struggling to gain health insurance, the Obama administration is extending a health law program that covers more than 100,000 Americans with preexisting conditions.

Obama administration officials said Thursday that the state-based "high risk pools" set up in 2010 will continue to offer coverage to existing members through the end of January rather than ending at sunset on Dec. 31.

"Today, as part of our efforts to smooth the transition to the Marketplaces for those seeking coverage that begins in January, we are taking steps to ensure that Americans enrolled in the federal PCIP insurance plan will not face a lapse when the new year begins." Medicare spokesman Aaron Albright said in a statement. "We are committed to providing consumers additional flexibilities while they evaluate and select a quality, affordable, health plan that meets their needs.”

Some officials involved with the program estimate that only about half of those high-risk enrollees in some states have successfully enrolled in insurance coverage through HealthCare.Gov.

The Pre-Existing Condition Insurance Program, or PCIP, was always intended as a temporary bridge for the uninsured that would sunset in 2014, when the health law requires insurance plans to accept all customers, including those with costly medical conditions.

The program covered just over 104,000 Americans as of last summer. While enrollment was lower than projected, those who did sign up had higher-than-expected medical costs, and, in February, the PCIP program stopped accepting new enrollees.

Now, officials at Health and Human Services believe that they have adequate funding to pay an additional month of claims using the original $5 billion in funding, based on the current number of enrollees and their utilization patterns.

The Affordable Care Act intended for the PCIP enrollees to transition into health law coverage by the end of this year. The law also gave the agency authority to "extend coverage after the termination of the risk pool involved if the Secretary determines [that] necessary to avoid such a lapse."

Cecil Bykerk, who runs state high-risk pools in Alaska, Iowa and Montana, has learned during phone calls with PCIP enrollees in two states that from 40 percent to 50 percent of those signed up had transitioned into new coverage. The rest either had not succeeded or were unreachable.

Patient advocacy groups welcomed the announcement.

"Extending the Pre-Existing Condition Insurance Plan will give tens of thousands of people with a history of cancer or another serious disease the security of knowing they will not face a costly gap in coverage on Jan. 1 if they cannot enroll in a marketplace plan by Dec. 23." American Cancer Society Action Network president Chris Hansen said. "People living with a chronic disease such as cancer must carefully weigh several factors when choosing a health plan, including premiums and other out-of-pocket costs, coverage of necessary care including prescription drugs, and available financial assistance options."

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Brad Plumer · December 12, 2013