The Pre-existing Condition Insurance Plan (PCIP) — a new health insurance program for people with health problems — ended 2011 with 48,879 enrollees.
That’s up from none in the summer of 2010, when the program started, officials at the Center for Consumer Information and Insurance Oversight (CCIIO) say in a new PCIP report.
But enrollment is running far below expectations. PCIP designers, and critics, originally were predicting that millions of Americans would rush to sign up for coverage.
The consumers who have enrolled have turned out to be far sicker than officials had anticipated: Enrollees are averaging about $29,000 in claims per year. That’s twice the average traditional state high risk pools have experienced in recent years, CCIIO officials say.
In Colorado, for example, officials have found that enrollees in a state health insurance risk pool program have 137 hospital admissions per 1,000 enrollees per year. The hospital admission rate for PCIP enrollees in Colorado is 562 admissions per 1,000 enrollees per year.
In another state, Kansas, claims expenditures have averaged $1,376 per member per month for state risk pool enrollees and $3,449 per member per month for PCIP enrollees, officials say.
The Patient Protection and Affordable Care Act of 2010 (PPACA) requires health insurers to sell subsidized coverage on a guaranteed issue, mostly community-rated basis starting in 2014.
PPACA drafters included the PCIP program in PPACA in an effort to provide temporary relief for consumers with pre-existing conditions who cannot qualify for commercial health insurance, Medicare or Medicaid.