Pre-existing condition insurance a flop in West Virginia
Print This Post
By Steven Allen Adams | West Virginia Watchdog
CHARLESTON — A federal plan providing temporary health insurance to people with pre-conditions has not met enrollment expectations.
Pre-Existing Condition Insurance Plans, made possible by the passing of the Patient Protection and Affordable Care Act in March 2010, were expected to cover 350,000 or more. Instead, as of June 30, 2011, only 27,489 people, or 7.85 percent, have signed up for these plans.
The $5 billion Pre-existing Condition Insurance Plan, or PCIP is open to U.S. citizens and nationals who have been uninsured for six months or longer and have had problems getting insurance due to their pre-existing conditions. The PCIP has a $2,000 medical deductible, a $500 prescription deductible, with an out-of-pocket limit at $5,950
The PCIP is available until 2014, when provisions of the health care reform law kick in, making it illegal to deny health care to people with pre-existing conditions. State health insurance exchanges are also supposed to open by 2014 and give individuals and business access to more health insurance options.
“For too long, Americans with pre-existing conditions have been locked out of our health insurance market,” said Kathleen Sebelius, secretary of of the Department of Health and Human Resources, in a 2010 press release. “The Pre-Existing Condition Insurance Plan gives them a new option – the same insurance coverage as a healthy individual if they’ve been uninsured for at least six months because of a medical condition.”
Some states manage their own PCIP programs, but 23 states and Washington D.C. chose to let the federal government manage their programs. Between July 1, 2010, when the federal PCIP program started taking applications, and June 30, 2011, only 30 West Virginia residents have applied for health insurance through the program. Out of all 50 states, West Virginia ranks in the bottom five for PCIP participation.
In comparison, according to data from the Kaiser Family Foundation there are 383,035 Medicare beneficiaries in West Virginia as of 2011. Medicare provides health insurance to people are 65 or older. Medicaid, which provides health insurance to people with low income, has 334,200 enrollees as of 2010. Medicare and Medicaid enrollees in West Virginia make up nearly 39 percent of the state population. According to Kaiser, nearly 15 percent of West Virginians are uninsured.
According to the Government Accountability Office, only 2 percent of the $5 billion program’s funding had been spent; about $78 million by state-run PCIPs and $26 million for the federally run PCIP. The GAO, in a report issued last month, chalked up the failure of the PCIP to several issues.
“Factors contributing to low enrollment include the statutory requirement that enrollees be uninsured for six months prior to applying; premiums that may be unaffordable to many; and a lack of PCIP awareness. In response, HHS reduced premiums in the federally run PCIP states and increased its outreach efforts in 2011.”
According to the GAO report, the federal PCIP set aside $27 million for West Virginia, and has paid out 118,947 in claims as of March 31, 2011. The overall monthly premium paid by West Virginians enrolled in the PCIP varied between $141-$451.
While the PCIP program has not attracted many enrollees, other temporary programs created by Affordable Care Act have been more successful. A total of nine state-based health insurance companies, businesses, and unions received health care waivers from the federal government. A total of 21 businesses and state and local governments have also benefited from federal funding of their funding retiree health care through the Early Retiree Reinsurance Program, which has already spent $5,311,543 for these retiree health care plans.
- West Virginia Receives Millions for Retiree Health Care (westvirginia.watchdog.org)
- GAO Drops In To See What Condition ObamaCare’s Pre-Existing Condition Plans Are In (reason.com)
- West Virginia businesses, unions receiving health care waivers (westvirginia.watchdog.org)
- Would You Spend Six Months Uninsured To Qualify For Affordable Health Coverage? (huffingtonpost.com)
Posted under Featured, Federal, News, West Virginia.
Tags: Government Accountability Office, Health insurance, Kathleen Sebelius, Patient Protection and Affordable Care Act, Pre-existing condition, Pre-existing Condition Insurance Plan, United State, West Virginia
Comments are closed.