The California Pre-Existing Condition Insurance Plan (PCIP) is growing rapidly, but the number of enrollees is still much lower than expected, and the average amount of claims per enrollee is much higher than expected.
The state’s Managed Risk Medical Insurance Board has reported on PCIP program performance in documents posted in connection with a recent board meeting.
If the Patient Protection and Affordable Care Act of 2010 (PPACA) takes effect on schedule and works as drafters expect, it will require insurers to start selling subsidized coverage on a guaranteed issue, mostly community-rated basis in 2014.
Congress added the PCIP program to PPACA in an effort to provide immediate relief for uninsured people with health problems.
PCIP is supposed to provide comprehensive health coverage for people with health problems for a price similar to the price of ordinary individual commercial health coverage.
Eligibility is not based on income, and the risk pools cannot charge higher rates for people with more severe health problems.
Congress let states choose between running PCIP risk pools themselves or letting HHS provide PCIP risk pool services for their residents.
To avoid crowding out existing commercial health coverage and government-provided coverage, including existing state-funded risk pools, PPACA drafters required that PCIP enrollees have gone without any form of health coverage, including state risk pool coverage, for at least 6 months.