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

Sen. Roy Blunt (R-MO) has offered an amendment that would allow employers to deny coverage of health services to their employees on the basis of their personal moral objections. Women’s groups warn the measure will severely limit access to needed care and now Brent Bozell, founder of the Media Research Center, is providing a sneak preview to the kind of discrimination employees will experience if the amendment becomes law.

Upon hearing news of President Obama’s regulation requiring all employers to offer contraception coverage without additional cost sharing, Bozell examined his own organization’s insurance policy and was “horrified” to learn that MRC’s plan has long provided contraception (and abortion) coverage. Bozell asked his employees to stop using “contraception/abortifacient/abortion services” and promised to eliminate the benefits at once:

“[W]e are working to change our insurance policy so as not to have to comply with this administration’s disgusting mandate to provide contraceptive, sterilization and abortifacient services. In the course of looking into this I have learned our insurance policy provides abortion services. I cannot begin to tell you how horrified I am by that. I never would have approved this had I known. It is the taking of a human life. That will change.”

If Congress approves Blunt’s amendment, employers like Bozell would be able to make health decisions for their employees on the basis of their own personal beliefs. About two-thirds of Americans oppose this idea, but Bozell is already putting it into practice.

The incident is reminiscent of the Republican National Committee’s reaction upon discovering — through an article in Politico — that its health insurance plan covered abortion in 2009. Like Bozell, the RNC did not change its policy until it contradicted its political rhetoric, suggesting that women’s health care benefits are standard insurance benefits and that the GOP’s sudden outrage is nothing more than a manufactured political issue designed to rally the Republican base.

Aetna CEO, Chairman and President Mark Bertolini praised the Affordable Care Act during the HIMSS12 Conference in Las Vegas this week, arguing that while the new law and its regulations have “pulled [the insurance industry] through the crucible” and “reshaped” the health care market, “For most of what has already been implemented, it has been a pretty good thing”:

So what will the health insurers look like in the future? Bertolini offered a strong endorsement of the accountable health organization model, positioning health insurers as uniquely suited to usher in an era of coordinated care. “We need to move the system from underwriting risk to managing populations,” he said. “We want to have a different relationship with the providers, physicians and the hospitals we do business with.” [...]

Pondering the future of the health care exchanges, Bertolini foresees the brands of health systems superceding those of health insurers. “We want to leverage or technologies and capabilities to allow you to be the face in marketplace,” he said.

Indeed, Bertolini says this new arrangement makes great sense from the perspective of the customer. The lack of coordination inherent in the current system stems largely from the various stakeholders acting rationally in their own self-interest. “For the patient it’s a nightmare. Think of a hockey game where everybody has their own puck.”

The Aetna chief also “discounted the prospect that the results of the 2012 presidential election or a Supreme Court decision striking down aspects of the ACA would deter the change,” noting, “Reform is not going to stop. It won’t go away.”

Insurers have generally accepted the inevitability of the ACA and have worked to shape its implementation to meet their needs. For instance, health lobbyists are pressuring Congress to repeal taxes on the industry, and have urged the Department of Health and Human Services to adopt exchange regulations that would allow almost all private insurers to participate in the new marketplaces and provide greater leeway for plans to design the standard essential health benefits package that will be offered in 2014. Insurers have also lobbied conservative governors to establish health care exchanges.

At the same time, the industry is preparing for the expansion of new customers. Last September, Cigna — one of the nation’s largest health insurers — kicked off a $25 million ad campaign designed to attract the individual consumers who will begin shopping for their own policies and the industry joined forces with health care and consumer groups to form the “Enroll America” campaign, an effort to “encourage states to make it easy for people to sign up for coverage, by providing model regulations” and “get the word out among the uninsured, through advertising and community outreach.”

Democrats on the House Democratic Steering and Policy Committee held a special hearing Thursday morning in response to the GOP’s decision to prevent women from testifying in support of an Obama administration rule requiring employers to provide birth control without additional cost sharing. The committee invited just one witness, Sandra Fluke, the third year Georgetown Law student, who House Oversight Committee Chairman Darrell Issa (R-CA) dismissed as an “energized” “college student” who was not “appropriate and qualified” to testify before his committee.

Democrats received over 300,000 requests for women to testify on the issue, House Minority Leader Nancy Pelosi (D-CA) said during today’s hearing, and the GOP’s male-only contraception hearing was widely spoofed in the press and on late-night comedy shows. Fluke herself responded to Issa’s snub in jest, noting, “Well, I will confirm that I was energized, yes” she said to laughter from the committee, “as you can see from the reaction behind me, many women in this country are energized about this issue.” “I’m an American woman who uses contraception, so let’s start right there. That makes me qualified to talk to my elected officials about my health care needs,” she added.

In her testimony, Fluke reiterated the story of her friend who was denied contraception coverage from Georgetown, despite technically qualifying for an exception that provided students who use birth control for health reasons with the benefit, and had to undergo invasive surgery. She also highlighted the confusion such policies cause, noting that while Catholic employers may claim that their insurance plans include loopholes for women who use birth control for non-reproductive purposes, beneficiaries still interpret the policy as a blanket exclusion of reproductive health benefits. One woman, for instance, did not seek medical treatment after being raped because she believed Georgetown did not provide coverage for women’s “sexual health care”:

FLUKE: One student told us that she knew birth control wasn’t covered, and she assumed that’s how Georgetown’s insurance handled all of women’s sexual healthcare, so when she was raped, she didn’t go to the doctor even to be examined or tested for sexually transmitted infections because she thought insurance wasn’t going to cover something like that, something that was related to a woman’s reproductive health.

Watch it:

Pelosi criticized Republicans for denying her request to have Fluke’s testimony covered by House-operated TV cameras and argued that the GOP was seeking to silence women on the issue in order to frame the discussion as a matter of religious liberty. Rep. Elijah Cummings (D-MD) pointed out, however, “if this was a hearing on prostate cancer and there was a lot of women and no men, I guarantee you men would not have stuck around.”

Mitt Romney defended a rule requiring insurers and employers to provide contraception coverage as part of their health insurance plans at Wednesday night’s GOP presidential debate in Arizona, so long as “people don’t have to have coverage for contraceptives or other type of medical devices which are contrary to their religious teachings.” The former Massachusetts governor was describing his own 2006 health care reform law, which greatly expanded access to contraception — but his characterization could also apply to President Obama’s contraception regulation. Watch the exchange:

“[T]here’s a provision in Massachusetts general laws that says people don’t have to have coverage for contraceptives or other type of medical devices which are contrary to their religious teachings,” Romney said. “Churches also don’t have to provide that to entities which are either the church themselves or entities they control.”

Under Romneycare, the state’s Commonwealth Care — which offers subsidized, low or no-cost insurance program for low-income residents without access to employer-sponsored health insurance — provides primary and preventive care that includes “family planning services” and prescription contraceptives. Massachusetts employers that are not “a church or qualified church-controlled organization” must also cover hormone replacement therapy and all FDA-approved contraceptive methods.

Romney argued that a similar regulation included in the Affordable Care Act would force “the Catholic Church to provide for its employees and its various enterprises health care insurance that would include birth control, sterilization and the morning-after pill.” The provision seeks to guarantee all women access to contraception without additional cost sharing, but actually exempts churches and nonprofits primarily serving people of the same faith from that mandate and, under a recent modification, would also allow religiously affiliated colleges, universities, and hospitals that raise religious objections to stop providing birth control coverage.

“We have to have individuals that will stand up for religious conscience, and I did and I will again as president,” Romney pledged at the debate. However, since Obama’s new federal standard would expand conscience protections beyond the “church or qualified church-controlled organization[s]” to include religiously affiliated nonprofits, his regulation would likely go further in meeting that goal than existing Massachusetts law. For instance, if Boston College is required to provide birth control under the law’s overseen by Romney in Massachusetts, it could drop the coverage — and leave the matter to its insurer — under Obama’s new requirement.

In 2005, Romney also “signed a bill that could expand the number of people who get family-planning services, including the morning-after pill.” Romney even pressured the state Department of Health and Human Services to issue regulations that required Catholic hospitals to issue the morning after pill to rape victims, despite initially vetoing the bill and claiming that the pill constituted an “abortifacient.” “My personal view in my heart of hearts is that people who are subject to rape should have the option of having emergency contraceptives or emergency contraceptive information,” he told the Boston Herald at the time.