PPACA clock is ticking for sickest patients

PORTLAND, Ore. (AP) — With federal and state health insurance exchanges experiencing glitches a month into implementation, concern is mounting for a vulnerable group of people who were supposed to be among the health law’s earliest beneficiaries.

Hundreds of thousands of people across the country with pre-existing chronic conditions such as cancer, heart failure or kidney disease who are covered through high risk-insurance pools will see their coverage dissolve by year’s end.

They are supposed to gain regular coverage under the Patient Protection and Affordable Care Act (PPACA), which requires insurers to cover those with severe medical problems. But many of them have had trouble signing up for health insurance through the exchanges and could find themselves without coverage in January if they don’t meet a Dec. 15 deadline to enroll.

Administration officials say the federal exchange, which covers more than half the states, won’t be working probably until the end of November, leaving people just two weeks to sign up if they want coverage by Jan. 1.

“These individuals can’t be without coverage for even a month,” said Tanya Case, the chairwoman of the National Association of State Comprehensive Health Insurance Plans, which represents the nation’s high-risk pools. “It’s a matter of life or death.”

State-based high-risk pools were created by state legislatures to provide a safety net for people who have been denied or priced out of coverage. While PPACA will forbid insurers from turning away people in poor health, those who qualify for a subsidy must enroll through the state or federal marketplace.

More than a dozen of the 35 states that run insurance pools for people with serious medical issues will permanently close their pools within a month and half. Other states will keep their pools running for a few more months.

The federal Pre-existing Condition Insurance Plan (PCIP) pool covers about 100,000 people and was created in 2010 by PPACA as a temporary bridge until the law fully kicks in. The PCIP program will cease to exist at the end of December.

“I’m scared. I’m in the middle of my cancer treatment, and if my insurance ends, I’m going to have to cancel the rest of my treatment,” said Kelly Bachi, an Oklahoma boat repair business owner who has breast cancer and is covered through a pool.

Cancer treatment without insurance would cost her about $500,000, she said.

Bachi has not been able to enroll via the healthcare.gov federal website, although not for lack of trying. She attempted to sign up half a dozen times, was eventually able to create an account, but was later blocked from accessing the account.

Others — including Jill Morin of Raleigh, N.C., who has a severe heart condition and is covered by her state’s pool — have not attempted to enroll.

“It’s the unknown, the uncertainty that gets to me,” Morin, 42, said. “I don’t know what my cost will be at the end of the day. I don’t know if my two cardiologists and my procedures are going to be covered under the plan. There just isn’t enough information on that website.”