The Pre-existing Condition Insurance Plan (PCIP) program is turning out to be smaller than expected, but also much more expensive.
Some experts had suggested that hundreds of thousands of uninsured Americans with health problems might rush to enroll in the program and quickly exhaust PCIP funding, which was provided by the Patient Protection and Affordable Care Act of 2010 (PPACA).
Congress created the PCIP program in an effort to help people with health problems in the years before new health insurance rules take effect.
If PPACA takes effect on schedule and works as affected, it will require health insurers to sell individual coverage on a guaranteed-issue, mostly community-rated basis.
But, in an effort to keep PCIP from crowding out existing public or private coverage, Congress required that applicants to have been uninsured for at least 6 months. Enrollees must pay rates comparable to the rates for private individual coverage in their communities.
As of December 2011, only 42,000 individuals had enrolled in PCIP programs, according to analysts at the National Conference of State Legislatures (NCSL), Denver.
Although enrollment is low, the people who have enrolled have had severe health problems and even higher levels of claims than originally expected.
Nine states already have warned the U.S. Department of Health and Human Services that they need more PCIP funding to keep their programs from going broke before 2014, when the new health insurance sales requirements are supposed to take, the NCSL analysts say.
The government has given California and New Hampshire more PCIP funding. Applications from Alaska, Colorado, Montana, New Mexico, Oregon, South Dakota and Utah are still pending, the analysts say.
GOOD(ISH) NEWS
Analysts at Moody's Investors Service, New York, have gotten tired of waiting for the other shoe to fall on top of health insurers and increased their outlook on health insurers to stable, from negative.
The shoe could still fall in 2014, but no new PPACA provisions are set to take effect between now and then, and even the much-feared minimum medical loss ratio requirement seems to be having less of a financial effect than some had anticipated, the Moody's analysts say.
A LADDER FOR THE TOWER OF HEALTH DATA BABEL
The employee benefits working group at ACORD Pearl River, N.Y., is talking about developing new standards for communicating health data through a standard Product Profile for Health, according to Michael Carroll of ACORD.
The group wants to create a message specification along with the elements and rules needed to make use of the specification, Carroll says.
The group is looking for input from organizations that are involved with communication employee benefits health data.
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