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Pennsylvania asks CCIIO to keep PCIP as is

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Pennsylvania Insurance Commissioner Michael Consedine is asking federal regulators to leave a federal health insurance program for people with serious health problems unchanged.

Consedine has written to Gary Cohen, the director of the Center for Consumer Information and Insurance Oversight (CCIIO), to ask CCIIO and its parent, the Centers for Medicare & Medicaid Services (CMS), to continue to run the Pre-Existing Condition Insurance Plan (PCIP) according to the terms that CCIIO negotiated in 2010.

The Pennsylvania Insurance Department “continues to diligently fulfill its role as the program administrator, and CCIIO should honor its commitment by paying the full costs” of Pennsylvania’s PCIP program, Consedine wrote in the letter.

PCIP officials were not immediately available to comment on the letter.

Drafters of the Patient Protection and Affordable Care Act of 2010 (PPACA) created PPACA to provide a temporary solution for uninsured people who were unable to qualify for affordable health coverage because they had serious health problems, such as heart disease or cancer. The program was supposed to last until Jan. 1, 2014, when PPACA is supposed to require health insurers to sell and price coverage without using personal health information other than age and location.

PPACA gave states the option of running their own PCIP programs or letting CMS — an arm of the U.S. Department of Health and Human Services (HHS) — provide PCIP coverage for their residents.

Enrollment in the program proved to be lower than expected, but claims costs were higher. Congress provided $5 billion in total funding for PCIP. The House recently put off acting on a bill that could have required HHS officials to use some of its funding to shore up PCIP.

CCIIO suspended new enrollment in state-run PCIP programs in March, and it told states in April 26 that they would have to accept a fixed amount of cash for most of the rest of 2012 or else shut down their programs and put the enrollees in the federal PCIP program. 

Pennsylvania has been running a state-run PCIP program, the PA Fair Care program, since October 2010. The state was running the program “pursuant to a federal commitment and written agreement to pay for all costs for the life of the program,” Consedine said.

Having state PCIP enrollees go into the federal program is not a good solution, because that would mean that vulnerable people would have to join new provider networks and face new premiums and deductibles, Consedine said.

Pennsylvania “is troubled by the anticipated disruption caused by the change of contract terms, particularly enrollees’ continuity of care,” Consedine said.

In an interview, Consedine said he had no complaints about how CCIIO had been working with Pennsylvania’s PCIP program up until February, when CCIIO announced the sudden end to processing of new applications for coverage.

“Everybody we’ve worked with at HHS is very dedicated,” Consedine said, adding that he believes that everyone at HHS and in Pennsylvania shares the goal of wanting to improve access to health care.

Consedine did not say what he thinks CCIIO official should do if the $5 billion in PCIP funding runs out and no other money is available.

He said he would have liked more time to think about CCIIO’s demand that states either agree to take a fixed payment or put their state program enrollees in the federal program, and to find other options.

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