Health Care Reform’s Pre-Existing Condition Insurance Plan Covers Fewer Than 50,000 of Millions With Pre-Existing Conditions

The Affordable Care Act created the new temporary Pre-Existing Condition Insurance Plan (PCIP) program to make health insurance available through 2014 to millions of Americans unable to get private health insurance due to pre-existing conditions through 2014.

Although the temporary the PCIP program began accepting applications for enrollment July, 2010 (July 1, 2010 for the federal program, dates for state programs varied), a recent report shows that very few Americans to date are receiving coverage from this program.

As of August 31, 2011, a recent report shows the PCIP Program only covered 33,958 people.  The following chart released October 14, 2011 by the Department of Health & Human Services shows the persons covered by the PCIP Program as of August 31, 2011 broken down by state

State

Federally/State Administered

Date Coverage for Enrollees Began (in 2010)

Number of People Enrolled and with Coverage in Effect Through August 31, 2011

Alabama Federal

01-Aug

182

Alaska State

01-Sep

43

Arizona Federal

01-Aug

967

Arkansas State

01-Sep

291

California State

25-Oct

3368

Colorado State

01-Sep

914

Connecticut State

01-Sep

68

Delaware Federal

01-Aug

95

District of Columbia Federal

01-Oct

36

Florida Federal

01-Aug

1906

Georgia Federal

01-Aug

1060

Hawaii Federal

01-Aug

57

Idaho Federal

01-Aug

123

Illinois State

01-Sep

1699

Indiana Federal

01-Aug

406

Iowa State

01-Sep

188

Kansas State

01-Aug

240

Kentucky Federal

01-Aug

223

Louisiana Federal

01-Aug

229

Maine State

01-Aug

28

Maryland State

01-Sep

551

Massachusetts* Federal

01-Aug

1

Michigan State

01-Oct

493

Minnesota Federal

01-Aug

111

Mississippi Federal

01-Aug

125

Missouri State

15-Aug

561

Montana State

01-Aug

249

Nebraska Federal

01-Aug

101

Nevada Federal

01-Aug

319

New Hampshire State

01-Jul

208

New Jersey** State

15-Aug

668

New Mexico State

01-Aug

592

New York State

01-Oct

1998

North Carolina State

01-Aug

2146

North Dakota Federal

01-Aug

20

Ohio State

01-Sep

1648

Oklahoma State

01-Sep

438

Oregon State

01-Aug

998

Pennsylvania State

01-Oct

3926

Rhode Island State

15-Sep

121

South Carolina Federal

01-Aug

665

South Dakota State

15-Jul

119

Tennessee Federal

01-Aug

578

Texas Federal

01-Aug

2650

Utah State

01-Sep

512

Vermont* Federal

01-Sep

0

Virginia Federal

01-Aug

590

Washington State

01-Sep

531

West Virginia Federal

01-Sep

41

Wisconsin State

01-Aug

772

Wyoming Federal

01-Aug

103

Total    

33958

*MassachusettsandVermontare guarantee issue states that have already implemented many of the broader market reforms included in the Affordable Care Act that take effect in 2014.  Existing commercial plans offering guaranteed coverage at premiums comparable to PCIP are already available in both states.

** Enrollment appears to have decreased in the New Jersey PCIP. However, this is attributable to a reporting error that affected prior months’ enrollment reports.

  • July 31, 2011 enrollment data available here
  • June 30, 2011 enrollment data available here
  • May 31, 2011 enrollment data available here
  • April 30, 2011 enrollment data available here
  • March 31, 2011 enrollment data available here  
  • February 1, 2011 enrollment data available here

 Join Project COPE To Continue Discussion & Help Promote Meaningful Health Care Reforms To Improve U.S. Healthcare

The outcome of this latest health care reform push is only a small part of a continuing process.  Whether or not the Affordable Care Act makes financing care better or worse, the same challenges exist.  The real meaning of the enacted reforms will be determined largely by the shaping and implementation of regulations and enforcement actions which generally are conducted outside the public eye.  Americans individually and collectively clearly should monitor and continue to provide input through this critical time to help shape constructive rather than obstructive policy. Regardless of how the policy ultimately evolves, however, Americans, American businesses, and American communities still will need to roll up their sleeves and work to deal with the realities of dealing with ill, aging and disabled people and their families.  While the reimbursement and coverage map will change and new government mandates will confine providers, payers and patients, the practical needs and challenges of patients and families will be the same and confusion about the new configuration will create new challenges as patients, providers and payers work through the changes.

We also encourage you and others to help develop real meaningful improvements by joining Project COPE: Coalition for Patient Empowerment here by sharing ideas, tools and other solutions and other resources. 

Other Helpful Resources & Other Information

We hope that this information is useful to you.   If you found these updates of interest, you also be interested in one or more of the following other recent articles published on the Coalition for Responsible Health Care Reform electronic publication available here, our electronic Solutions Law Press Health Care Update publication available here, or our HR & Benefits Update electronic publication available here .  You also can access information about how you can arrange for training on “Building Your Family’s Health Care Toolkit,”  using the “PlayForLife” resources to organize low cost wellness programs in your workplace, school, church or other communities, and other process improvement, compliance and other training and other resources for health care providers, employers, health plans, community leaders and others here. If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail by creating or updating your profile here. You can access other recent updates and other informative publications and resources

For important information concerning this communication click here

©2010 Solutions Law Press.  All rights reserved.

Personal Responsibility: How Should It Play Into Who Gets Help Under Health Care Reform?

The following was shared with me by a third party, who says it is the text of a two  paragraph letter of a young emergency room physician named Dr. Starner Jones.  I don’t know if this is a true letter or an urban legend letter.  However it’s perspective about health care reform as a “Culture Crisis” rather than a “Health Care Crisis” is thought provoking –  at least with regard to those Americans who claim they can’t pay for health insurance coverage or pay for the cost of health care for themselves or their families but can find money to pay for other “Necessities.”

The letter as shared reads as follows:

“Dear Mr. President:

During my shift in the Emergency Room last night, I had the pleasure of evaluating a patient whose smile revealed an expensive shiny gold tooth, whose body was adorned with a wide assortment of elaborate and costly tattoos, who wore a very expensive brand of tennis shoes and who chatted on a new cellular telephone equipped with a popular R&B ring tone. While glancing over her patient chart, I happened to notice that her payer status was listed as “Medicaid”! During my examination of her, the patient informed me that she smokes more than one costly pack of cigarettes every day and somehow still has money to buy pretzels and beer. And, you and our Congress expect me to pay for this woman’s health care? I contend that our nation’s “health care crisis” is not the result of a shortage of quality hospitals, doctors or nurses. Rather, it is the result of a “crisis of culture”, a culture in which it is perfectly acceptable to spend money on luxuries and vices while refusing to take care of one’s self or, heaven forbid, purchase health insurance. It is a culture based in the irresponsible credo that “I can do whatever I want to because someone else will always take care of me”. Once you fix this “culture crisis” that rewards irresponsibility and dependency, you’ll be amazed at how quickly our nation’s health care difficulties will disappear.

Respectfully,

STARNER JONES, MD”

When deciding to tax or otherwise collect money from some Americans to pay for health care for other “needy” Americans, should some consideration be given to why the person asking for or being given the help “needs’ the help and why the person being asked or forced to help is able and expected to help.  

Some Americans who need more health care than they can afford to pay for are in a tough position despite their honest hardworking efforts.  Many of these individuals have worked hard, scrimped and saved, purchased health insurance, and done their part only to loose their job or be hit with an illness or injury requiring more care than their budget can handle. 

On the other hand, many people holding out their hand for health care assistance could have purchased health care coverage or better health care coverage but chose not to guard against a rainy day or don’t pay their health care coverage or medical expenses because they choose to buy other things that are more satisfying.  Many of these people making these choices also may make other unhealthy choices.

Should the help given depend on these choices?  How does personal responsibility weigh into the health care reform debate?  Share your point of view by joining the discussion at http://www.linkedin.com/groups?gid=3049544&trk=hb_side_g.

For More Information

We hope that this information is useful to you.  If you need assistance with these or other health care public policy, regulatory, compliance, risk management, workforce and other staffing, transactional or operational concerns, please contact the author of this update, Curran Tomko Tarski LLP Health Practice Group Chair, Cynthia Marcotte Stamer, at (214) 270‑2402, cstamer@cttlegal.com, Ms. Stamer has extensive experience advising clients and writes and speaks extensively on these and other health industry and other reimbursement, operations, internal controls and risk management matters. 

Ms. Stamer has extensive experience in these health care reform, public policy and other health industry related representation.  You can review other recent health care and related resources and additional information about the health industry and other experience of Ms. Stamer here

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at here, or e-mailing this information to cstamer@cttlegal.com, and/or by participating in the SLP Health Care Risk Management & Operations Group

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at here or e-mailing this information here.  To unsubscribe, e-mail here.

©2011 Cynthia Marcotte Stamer.  All rights reserved.

ONC Awards Key Contract To Develop Patient Electronic Consent Trial Project

One of the key elements to maximizing electronic health care transactions is determining how patients will provide their consents electronically.  Stiking the correct balance between ensuring patient understanding and ability to effectively express their consent while making it financially and operationally viable for health care providers and payers to use the electronic consent process is a challenging but critical process.  

One of the key elements to maximizing electronic health care transactions is determining how patients will provide their consents electronically.  Stiking the correct balance between ensuring patient understanding and ability to effectively express their consent while making it financially and operationally viable for health care providers and payers to use the electronic consent process is a challenging but critical process. 

ONC’s Office of the Chief Privacy Officer recently awarded a contract to APP Design, Inc. to find an efficient, effective, and creative way to help patients better understand their choices about whether and when their health care provider can share their health information electronically, including sharing it with a health information exchange organization. The project team will design, develop, and pilot innovative ways to electronically carry out existing patient choice policies, while improving business processes for health care providers. To learn more about the E-Consent Trial project, please see the Statement of Work.

ONC’s formal launch of the E-Consent Trial Project begins this month.  

ONC’s Office of the Chief Privacy Officer recently awarded a contract to APP Design, Inc. to find an efficient, effective, and creative way to help patients better understand their choices about whether and when their health care provider can share their health information electronically, including sharing it with a health information exchange organization. The project team will design, develop, and pilot innovative ways to electronically carry out existing patient choice policies, while improving business processes for health care providers. To learn more about the E-Consent Trial project, please see the Statement of Work. ONC’s formal launch of the E-Consent Trial Project will be in October. 

All concerned parties should carefully monitor and provide input to help shape this project to promote the best possible outcome.

Participation Key To Promoting Quality Health Policy Choices & Implementation

The best opportunity to improve access to quality, affordable health care for all Americans is for every American, and every employer, insurer, and community organization to seize the opportunity to be good Samaritans.  The government, health care providers, insurers and community organizations can help by providing education and resources to make understanding and dealing with the realities of illness, disability or aging easier for a patient and their family, the affected employers and others. At the end of the day, however, caring for people requires the human touch.  Americans can best improve health care by not waiting for someone else to step up:  Speak up, step up and help bridge the gap when you or your organization can do so by extending yourself a little bit.  Speak up to help communicate and facilitate when you can.  Building health care neighborhoods filled with good neighbors throughout the community is the key.

The outcome of this latest health care reform push is only a small part of a continuing process.  Whether or not the Affordable Care Act makes financing care better or worse, the same challenges exist.  The real meaning of the enacted reforms will be determined largely by the shaping and implementation of regulations and enforcement actions which generally are conducted outside the public eye.  Americans individually and collectively clearly should monitor and continue to provide input through this critical time to help shape constructive rather than obstructive policy. Regardless of how the policy ultimately evolves, however, Americans, American businesses, and American communities still will need to roll up their sleeves and work to deal with the realities of dealing with ill, aging and disabled people and their families.  While the reimbursement and coverage map will change and new government mandates will confine providers, payers and patients, the practical needs and challenges of patients and families will be the same and confusion about the new configuration will create new challenges as patients, providers and payers work through the changes.

We also encourage you and others to help develop real meaningful improvements by joining Project COPE: Coalition for Patient Empowerment here by sharing ideas, tools and other solutions and other resources. 

Other Helpful Resources & Other Information

We hope that this information is useful to you.   If you found these updates of interest, you also be interested in one or more of the following other recent articles published on the Coalition for Responsible Health Care Reform electronic publication available here, our electronic Solutions Law Press Health Care Update publication available here, or our HR & Benefits Update electronic publication available here .  You also can access information about how you can arrange for training on “Building Your Family’s Health Care Toolkit,”  using the “PlayForLife” resources to organize low cost wellness programs in your workplace, school, church or other communities, and other process improvement, compliance and other training and other resources for health care providers, employers, health plans, community leaders and others here. If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail by creating or updating your profile here. You can access other recent updates and other informative publications and resources

For important information concerning this communication click here

©2010 Solutions Law Press.  All rights reserved.