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Report: 50,000 Americans With Pre-Existing Conditions Find Coverage As A Result Of Health Reform

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"Report: 50,000 Americans With Pre-Existing Conditions Find Coverage As A Result Of Health Reform"

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The Affordable Care Act’s Pre-Existing Condition Insurance Plan (PCIP) is credited with providing comprehensive health coverage to nearly 50,000 Americans with high-risk pre-existing conditions, according to a report released today by the Department of Health and Human Services. The PCIP is a temporary program intended to make health coverage available and more affordable for individuals who are uninsured — and were likely denied coverage based on their pre-existing conditions — and are ineligible to receive Medicare and Medicaid. Once the health reform law is fully implemented, in 2014, insurers will be prohibited from refusing coverage to any American with a pre-existing condition.

Since its launch in November 2010, there has been an approximate 400 percent increase in PCIP enrollment — specifically amongst older uninsured Americans, who’s serious pre-existing conditions require more intensive and ongoing medical care — with the PCIP program attracting 8,000 new applications every month from August through November 2011.

PCIP enrollees are immediately granted access to the most basic medical treatments, including primary and specialty care, hospital care, prescription drugs, home health and hospice care, skilled nursing care, preventive health and maternity care, but because of the severity of many of the enrollees’ conditions, 78 percent of the total cost to run the program is spent on providing care for four types of potentially life-threatening medical needs, such as: cancer, circulatory diseases (i.e. coronary artery disease), degenerative joint diseases, and rehabilitative care/aftercare (i.e. radiation and chemotherapy).

In 2011 the Federally-administered PCIP served 628 enrollees with cancer, including 333 enrollees diagnosed with breast cancer, and covered more than 1,000 enrollees with a diagnosis of either ischemic heart disease or heart failure. Assuming that the risk profile of the Federally-administered PCIP population is reflective of the program as a whole, we estimate that the PCIP program served nearly 1,900 individuals with cancer and approximately 4,700 people with heart disease in 2011.

A recent study examined a sample of 1,485 enrollees in 10 state-based PCIPs and found that 18.7 percent of individuals had joint disease, 16.8 percent of individuals had diabetes or other disorders of the endocrine system, and 15.4 percent had cardiovascular disorders. The top five diagnoses or procedures by cost vary by State, but typically include cancers, ischemic heart.

Some states have had trouble getting the high risk pools off the ground and have either relied on existing state programs or offered patchy benefit packages“. The transition to the new pools has been less than flowing, with enrollment failing to meet the Obama administration’s projections, and while most states still have yet to exceed their operating budgets, at least nine have burned through their money and are currently requesting additional funding — Alaska has spent $13 million on just 45 people. Costs have also stunted enrollment rates, as premiums remain impossibly high, even after the federal government’s decision to reduce them in an attempt to appeal to more people.

Fatima Najiy

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