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PCIP Enrollment Far, Far Below Expectations In First Year

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HEALTH CLINIC
People line up for an appointment for a free medical clinic at the Sports Arena in downtown Los Angeles on Sunday April 25, 2010. | AP

WASHINGTON -- Enrollment in a new federal program for the uninsured is far below expectations from when the program launched following the enactment of health care reform last year.

Since its creation in July 2010, the Pre-Existing Condition Insurance Plan has insured 30,395 people, according to the Department of Health and Human Services, which oversees the program. Officials initially estimated the initiative could reach as many as 375,000 by the end of 2010. There are up to 25 million uninsured Americans who have pre-existing conditions like heart disease or diabetes.

The most recent enrollment numbers are the first to reflect HHS efforts to make the program more affordable and more accessible, according to an HHS official. In the 23 states where the federal government runs the program directly, enrollment in July jumped to 8,712, a 15 percent boost from the previous month, before new lower premiums took effect.

The PCIP provides market-rate health coverage for uninsured people shunned by the health insurance industry. A recent government audit said the biggest obstacles to higher enrollment are costly premiums and the requirement that applicants be uninsured for six months to be eligible. Another problem is a lack of awareness about the program.

Olivia Grey Pritchard, a freelance photographer in New Orleans, said she didn't hear about the PCIP until she complained about her fruitless search for insurance on Facebook. Pritchard has been uninsured since returning from Africa earlier this year, where she said her insurance had been provided by the humanitarian organization that had hired her to take pictures.

She said her Facebook complaint went something like this: "I am willing to pay, so it is absolutely ridiculous I can't get coverage because of a benign tumor from seven years ago."

A friend sent her a few informative links. "At first I was really shocked I hadn't come across it," said Pritchard, 30. "Nobody knows about it. Nobody has signed up for it. Nobody's talking about it."

An HHS official said the administration has been doing more outreach to increase the PCIP's enrollment.

"In just the past two weeks we have engaged in over 115 events across the country to highlight the program," the official said. "These events work to educate people about the program, especially those most likely to interact with people potentially eligible for PCIP -- pharmacists, social workers, providers at local health community centers, etcetera."

Monthly premiums for the PCIP in Louisiana can be as low as $193, but Pritchard is waiting to sign up. She said that when she called HHS to ask about a policy, she was told the $1,000 deductible would reset in January -- meaning that she'd have to pay $1,000 for her own care between now and then before the plan started covering her costs. She's waiting until the beginning of next year to apply so that she can get the most out of the program.

Though the requirement that applicants be uninsured for six months has been cited as a main reason for low enrollment, several people have told HuffPost they canceled expensive policies just so they could sweat out six months for a more affordable plan.

Richard Vieira, a 54-year-old accountant who lives near San Francisco, Calif., said he dropped his $1,100-per-month policy in December and received PCIP coverage in July, but not without some trouble. He said that in April, he had to go to the hospital for an appendectomy that cost more than $100,000. (Vieira said he hired a consulting firm to negotiate with the hospital, resulting in a drastically lower bill.)

"It was just about right in the middle of my wait. I felt pretty unlucky," Vieira said. "Prior to that I was hardly using the insurance at all."

Arthur Delaney is the author of "A People's History of the Great Recession," HuffPost's first e-book.

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