GAO: Federal Risk Pool Awkward, Costly

The new federal Pre-Existing Condition Insurance Plan (PCIP) program is hard to get into, too expensive for the typical uninsured individual with a chronic illness, and under-promoted, according to officials at the U.S. Government Accountability Office (GAO).

John Dicken, a GAO director, writes about those findings in a summary of a PCIP study conducted at the request of Sen. Mike Enzi, R-Wyo., the highest ranking Republican on the Senate Health, Education, Labor and Pensions Committee.

Health policy watchers once predicted the federal PCIP risk pool program would attract more than 200,000 uninsured Americans with health problems, and that program managers would soon have to shut out many applicants.

GAO officials found that, in the real world, total PCIP enrollment stood at just 21,454 in April.

“Early PCIP enrollment has been significantly lower than initially projected,” Dicken says.

Congress added the PCIP program to the Patient Protection and Affordable Care Act of 2010 (PPACA) to provide immediate relief for uninsured people with health problems. PCIP is meant to help fill the gap between the date PPACA was signed in March 2010 and the day when insurers are supposed to start selling subsidized coverage on a guaranteed issue, mostly community-rated basis in 2014.

PCIP provides comprehensive health coverage for people who have a hard time qualifying to buy ordinary individual commercial health coverage.

Eligibility is not based on income. The price of coverage is supposed to be comparable to what healthy people would pay for health coverage purchased through the conventional market.

To avoid crowding out private health coverage, Congress required that people with health problems be uninsured for at least 6 months before applying for PCIP.

Congress let states choose between running PCIP risk pools themselves or letting the U.S. Department