Health Insurance Navigator

By Lisa Zamosky

Last week, the Department of Health and Human Services announced that the government’s high-risk insurance pools – Pre-Existing Health Insurance Plans (PCIPs) – are now providing coverage to 50,000 Americans who were otherwise uninsurable.

The health reform law set aside $5 billion to fund the program, which is intended to function as a bridge between now and 2014, when the Affordable Care Act makes it illegal for insurance companies to deny anyone coverage, regardless of their medical condition.

Today, 27 states operate their own PCIP program and 23 states and the District of Columbia have opted for the federal government to operate the program for them.

PCIP Breakdown

The report by HHS highlights a number of individual stories of people who have been able to get insurance coverage, and in some cases, life-saving medical treatment because of the PCIP program’s existence.

Also outlined is the breakdown of those enrolled by demographics and illness. Data show that 78% of the total cost of the federally run programs goes to providing care for four diseases:

• Cancer accounts for 27% of total costs
• Diseases of the circulatory system (e.g. coronary artery disease) make up 18.6%
• Rehabilitative care and aftercare (care post-surgery, radiation, chemotherapy) account for 18%, and
• Degenerative joint diseases, such as osteoarthritis make up 14.4% of costs.

Although there are more uninsured men in the general U.S. population than women, more women are enrolled in PCIPs than men. The population also leans toward older, with most of those enrolled age 45 and up.

Improved, but Unimpressive Enrollment Numbers

Some states have spent their allotted budget on PCIPs and are capping enrollment while many others have been underwhelmed by the number of people signing on.

Although the government’s report states that enrollment in PCIPs increased by nearly 400% between November 2010 and November 2011, the 50,000 who have thus far enrolled falls far short of the government’s initial prediction that 375,000 people would enroll by the end of 2010.

A number of reasons have been cited for the low PCIP turnout – initially, insurance agents weren’t paid much to recommend the program, the premiums were pricey, and the requirement that someone be without insurance for six months in order to qualify has been a high bar for many people to clear.

My Unofficial, Unscientific Poll

I have to admit that despite all the reasons cited, the low turnout for PCIPs is something I have found perplexing since the program got its start in July, 2010.

No doubt, cost is a factor for many people, and it’s been widely reported as one of the major barriers to the program. Still, PCIPs are a decidedly good deal in today’s insurance market, particularly measured against comparable coverage available to someone buying insurance on his or her own (which, of course, wouldn’t be available at all to someone with a pre-existing medical condition).

In my own state of California, for example, the cost of a plan is $428 for a 50-year old subscriber living in San Francisco. If you’ve ever shopped for private insurance, you know that’s not a bad deal, especially for someone who has high medical expenses.

And with approximately 50 million uninsured people in this country, it would seem that more than 50,000 might be in a position to fork over $400 or even $700 or so each month for fairly comprehensive insurance coverage, given the opportunity to protect themselves against huge medical bills.

So, help me understand the anemic enrollment in these plans.

Do you work in insurance? If so, what do you believe are the barriers to these programs? If you’re uninsured and have looked into your state’s PCIP program, did you sign on? Or did you pass on the coverage because the price was too high? Did you even know about the plan, or is this the first time you’re hearing of it? Share your thoughts in the comment section below.

And check out details of the PCIP program available in your state.