As many as 135,000 individuals enrolled in federally funded programs for people with pre-existing conditions will be given a few more weeks to find replacement coverage for next year through Obamacare's health insurance exchanges, the Centers for Medicare and Medicaid Services announced Thursday.
The Affordable Care Act established the $5 billion Pre-Existing Condition Insurance Plan (PCIP) in 2010 as a bridge to the exchanges, and the program was set to expire at the end of this year. But given the ongoing difficulties in using HealthCare.gov and several state-run health insurance marketplaces, concerns have grown that these sickest beneficiaries could find themselves uninsured next month, which could disrupt their medical care and expose them to extraordinarily high costs.
Under the policy announced Thursday, PCIP beneficiaries in 40 states and the District of Columbia, where the federal government operates the program, would have until the end of January to enroll in new coverage via the health insurance exchanges. Ten states run the program for their residents on behalf of the federal government and would have to sign off on the extension, according to the Centers for Medicare and Medicaid Services.
These so-called high-risk pools are supposed to become obsolete because Obamacare prohibits health insurance companies from rejecting anyone on the basis of pre-existing conditions or charging such people higher rates than healthy individuals.
But the troubled rollout of the centerpiece of the Affordable Care Act has jeopardized insurance coverage for as many as several million people, including those whose current policies can't be renewed because they don't meet the law's benefit standards and those enrolled in the PCIP and similar state-run programs, many of which also are shutting down in the coming months.
"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," Centers for Medicare and Medicaid Services spokesman Aaron Albright said in an email. "We are committed to providing consumers additional flexibilities while they evaluate and select a quality, affordable health plan that meets their needs."
Despite encouraging signs of improvements to HealthCare.gov, the federal portal to insurance marketplaces in more than 30 states, and rising enrollments during November and the early part of December, time is running short for people to lock in health benefits for next month. The PCIP covers more than 135,000 people nationwide.
Oklahoma, one of the 10 states running the PCIP for the federal government, will extend the program into January, said Tanya Case, executive director of the Oklahoma Temporary High Risk Pool. Case also chairs the National Association of State Comprehensive Health Insurance Plans (NASCHIP), a trade group for the programs. Alaska, Connecticut, Maryland, Maine, Montana, New Jersey, New Mexico, Oklahoma, Rhode Island and Wisconsin also operate the federal program and will have to make their own decisions, she said.
"NASCHIP commends the Obama administration decision to extend the PCIP," Case said in a written statement. Case had previously requested a three-month extension and believes the Department of Health and Human Services should remain open to further lengthening the time that PCIP enrollees have to replace their coverage if problems persist with the health insurance exchanges, the statement said.
Other consumers seeking to use the federally operated exchange have until Dec. 23 to select a plan that will be in place on Jan. 1, 2014, and must make their first payment to the insurance company of their choice by Dec. 31. Some of the 15 state-run exchanges have different deadlines.
A leading advocacy organization for chronically ill people praised the Obama administration for taking steps to protect vulnerable patients.
"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," Chris Hansen, president of the American Cancer Society Cancer Action Network, said in a press release.
Thirty-five states operate high-risk pool insurance plans, which predate Obamacare and cover about 200,000 people, and more than a dozen of them are slated to close down by next year. Several state-run high-risk pool programs have opted to extend their benefits into next year to ensure continuity of coverage, including those in Indiana, Texas and New Hampshire.
The PCIP has been troubled since its debut. Enrollment never reached projected levels but funding ran short anyway, forcing the administration to stop accepting new members in February.
The story has been updated with comment from the chair of the National Association of State Comprehensive Health Insurance Plans.