Podcast Center
Video Center
Webcasts
Resource Center
Events
December 13, 2011 at 09:56 AM
The painful birth of the federal Pre-Existing Condition Insurance Plan (PCIP) program — a health insurance program for people with health problems — may be due more to restrictions imposed by Congress than major problems with implementation.
John Dicken, a director at the U.S. Government Accountability Office (GAO), gives that assessment in a PCIP review requested by Senate Democrats.
The senators asked the GAO to compare the early progress of the PCIP program to the early progress of the Children’s Health Insurance Plan (CHIP) program.
Dicken notes that Congress tried to keep PCIP risk pool coverage from crowding out existing public and private sources of coverage for people with health problems by requiring that PCIP applicants be uninsured for at least 6 months.
The 1997 law creating CHIP does not include any specific methods for excluding children who already have other health coverage, Dicken writes.
The 6-month no-coverage requirement for PCIP applicants is “the most common factor explaining lower than expected enrollment cited by the state PCIP officials we interviewed,” Dicken says.
Because of the requirements spelled out in the law that created the PCIP program, PCIP coverage costs an average of about $400 per month for a 50-year-old applicant, and the cost of the coverage is another reason for slow early enrollment growth, Dicken says.
“In contrast, many states did not charge any CHIP premiums, and among those states that did, premiums were significantly lower compared to PCIP,” Dicken says.
Congress added the law that created the PCIP program to the Patient Protection and Affordable Care Act of 2010 (PPACA) in an effort to provide immediate relief for people who have a hard time buying health coverage because they have conditions such as obesity, high blood pressure, cancer or hemophilia.
