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Health Care Reform Program That Covers Pre-Existing Conditions Sees Low Enrollment

Hospital

First Posted: 10/20/11 04:48 PM ET Updated: 12/20/11 05:12 AM ET

WASHINGTON -- Fewer than 34,000 Americans have signed up for a health care reform program designed to insure the uninsurable until the new law's broader provisions take effect in 2014.

Enrollment in the Pre-Existing Condition Insurance Plan (PCIP) has been far below all expectations, including one estimate that 375,000 people would sign up in 2010 alone. From July to August, only 3,563 signed up, according to the Department of Health and Human Services, which oversees the initiative. As many as 25 million Americans are uninsured and have pre-existing conditions.

In order to apply for PCIP, applicants must have a pre-existing medical condition such as heart disease, cancer, asthma, or diabetes, and they must have been uninsured for at least six months. Enrollees can expect basic health benefits such as prescription drugs, physician visits and hospital care.

The low enrollment figures can be partially explained by the fact that PCIP offers market-rate insurance premiums, which many people can't afford. Yet the biggest obstacle to higher enrollment, according to health policy experts and a government audit, is the six-month waiting period the program imposes.

The Government Accountability Office (GAO) cited the six month requirement as a major drawback and called it a contributing factor to low enrollment. Though the PCIP caps out-of-pocket spending for U.S. citizens and offers many other benefits, individuals with pre-existing health conditions may be hesitant to live entirely without coverage for six months.

"Congress made a fatal mistake by imposing the six months of un-insurance requirement," said Tim Jost, health care expert and law professor at Washington and Lee University. "I bet the numbers would be far higher if people could enroll without going bare for 6 months."

Twenty-three states and the District of Columbia chose to have their PCIP program administered by the federal government while the rest are implementing the PCIP on the state-level. Only one person in Massachusetts has signed up for the program, and none have in Vermont, because those states, according to HHS, "have already implemented many of the broader market reforms included in the Affordable Care Act that take effect in 2014."

The PCIP is modeled on existing state programs known as "high-risk pools," which provide insurance for individuals whose pre-existing conditions prevent them from purchasing affordable insurance on the private market. Expanding state high risk pools was the centerpiece of the Republican alternative to President Obama's Affordable Care Act, which was signed into law last year.

"This also shows that the Republican solution of high-risk pools for those with pre-existing conditions is highly problematic," Jost said.

Arthur Delaney contributed reporting

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