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Life Health > Health Insurance > Your Practice

Help for 'uninsurables' mired in political battle

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WASHINGTON (AP) — Republicans are offering to bail out a financially strapped program in the federal health overhaul, one that’s a lifeline for uninsured people with medical problems. Truce in the health care wars? Not!

The GOP bill, headed for a vote Wednesday in the House, would divert billions from another program under the Patient Protection and Affordable Care Act (PPACA), a transfer Democrats say would undermine broader goals.

Caught in the middle are the so-called uninsurables, people like Susan Zurface, a small-town lawyer from Ohio with a recent diagnosis of leukemia, no health insurance and medical bills piling up. The Pre-Existing Condition Insurance Plan (PCIP) was designed to offer them a path to private coverage.

“For people like me who can’t afford the insurance, it doesn’t matter where the Republicans want the money to come from or where the Democrats want the money to come from — it has to come from somewhere,” said Zurface, who lives in the rural southwestern Ohio community of Hillsboro. She has a slow-growing form of the blood cancer and wants to start tackling it now when she is in her 40s and otherwise in good health.

“I’m starting to feel that sense of panic because I have no idea where the money is going to come from to pay for this,” added Zurface, a solo practitioner who focuses on representing children caught in family breakups.

PPACA was supposed to banish such fears forever by requiring health insurance companies to cover people with pre-existing medical problems. But those consumer protections don’t take effect until Jan. 1, along with a mandate that virtually every American must get coverage, expanding the insurance pool to try to keep costs in check.

Until then, the pre-existing conditions plan — known as PCIP — was supposed to help. It guarantees private coverage at average rates to people who had problems getting insurance because of a medical condition and were uninsured for at least six months. It would disappear in 2014.

But Congress allocated a limited amount of money. And in February, the Obama administration said it would stop taking new applications to ensure enough money would be left to cover more than 100,000 people already enrolled.

Zurface said her completed application was sitting on a table at home, ready to go out, when she got the news. She had no inkling the program was in financial trouble.

PCIP patients have turned out to be sicker and costlier than anticipated. But in his budget, Obama did not ask Congress for emergency funding to keep the program going.

House Republicans say they want to help Zurface and others like her by providing up to $3.6 billion to not only keep the doors open for new patients, but also expand it by eliminating the requirement that applicants be uninsured for six months before they qualify. Meant to deter people from dropping private coverage to take advantage of a government-sponsored plan, that particular feature has been criticized as a stumbling block for patients.

The money would come from another program in the health care law, the Prevention and Public Health Fund, which is supposed to be used for public health activities. In the GOP bill, called the Helping Sick Americans Now Act, all unallocated money from the prevention fund for 2013-2016 would be diverted.

That’s no mere bookkeeping transfer because the Obama administration plans to use at least $300 million from the prevention fund to publicize the new health insurance exchanges coming this fall under the health care law.

Health and Human Services Secretary Kathleen Sebelius said she has had to resort to using the prevention fund because congressional Republicans have refused to provide the administration with the financing needed to put the health law into place. Sebelius says prevention money can legally be used for educational and community outreach purposes.

People who don’t already get coverage on the job will be able to buy private insurance with new tax credits to help pay premiums. Nearly 30 million uninsured Americans are eventually expected to gain coverage through the broader law.

“The prevention fund is essentially a slush fund for Secretary Sebelius,” said Rep. Michael Burgess, R-Texas. “How about using some of the money to take care of people outside your door?”

Burgess said the PCIP program is an “Obamacare” poster child: “big promises to people, and at the end of the day it’s not delivering.”

But Rep. Lois Capps, D-Calif., called the Republican measure “a gotcha bill.” She said Democrats also want to keep the PCIP program going, but they want to pay for it by rolling back some oil and gas company tax breaks.

Democrats point out that the Republican bill takes about $800 million more out of the prevention fund than would be needed to finance continued operation of the insurance plan for people with medical problems. Republicans say that just reduces the deficit.

“They’ve spent more than a year trying to undo the Affordable Care Act, and now they are just trying to chop it up,” Capps said of the Republican majority in the House.

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