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Robert Longley

Pre-Existing Condition Insurance Plans Ready to Go

By July 5, 2010

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The U.S. Department of Health and Human Services (HHS) has announced the creation of the Pre-existing Condition Insurance Plan (PCIP) making health insurance available to Americans previously denied coverage because of pre-existing health conditions.

Created under the Patient Protection and Affordable Care Act (the health care reform act), the Pre-Existing Condition Insurance Plan will remain in effect until 2014, when health insurance companies will be banned from discriminating against adults with pre-existing conditions. Starting in 2014, individuals and small businesses will have access to what the government promises will be more affordable private insurance choices through new competitive Insurance Exchanges.

The Pre-Existing Condition Insurance Plan will be administered either by a state or the Department of Health and Human Services (HHS). So far, 21 states have chosen to have HHS administer the plans, while 29 states and the District of Columbia have chosen to run their own programs (See map).

Who Can Get Coverage? Under the Pre-Existing Condition Insurance Plan, coverage will be available to Americans who have been uninsured for at least six months, have been unable to get health coverage because of a health condition, and are a U.S. citizen or are residing in the United States legally.

When Will Coverage be Offered? According to HHS, coverage under the Pre-Existing Condition Insurance Plan is now available in the 21 states where HHS is operating the program. All states which are operating their own Pre-Existing Condition Insurance Plans will begin enrollment by the end of this summer, with many already enrolling applicants (See map).

"For too long, Americans with pre-existing conditions have been locked out of our health insurance market," said HHS Secretary Kathleen Sebelius in a press release. "Today, the Pre-Existing Condition Insurance Plan gives them a new option -- the same insurance coverage as a healthy individual if they've been uninsured for at least six months because of a medical condition."

Also See:
Health Care Reform: What You'll See First
Health Care Reform Watchdog Now on Duty
Small Business Health Care Tax Credit

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July 13, 2010 at 3:56 pm
(1) Peter S. Chamberlain says:

Interesting question, to which I have and have seen no answer, why the map reveals that most of the more conservative states have chosen to let Federal HHS, and many of the more liberal states have chosen state operation, of the plan for those of us with pre-existing conditions.
I’ve represented insurance companies and dealt with the Insurance Commissioner’s office, and state regulation of insurers is a sick dirty joke. I’ve seen one of the original letters, on official state letterhead, though allegedly “not printed or mailed at government expense,” where the Insurance Commissioner write to “John Doe, President, XYZ Insurance Company, our insurance company client, at its office address, on his Commissioner’s letterhead, pointed out that he was [also] LBJ’s Campaign Finance Chair, and strongly suggested that a contribution to this worthy cause should be madein at last a specified substantial amount promptly. The funny part was that, upon receiving this request from the Commissioner, the genius serving as company president sent him a company check in the amount “suggested,” which, of course, the campaign could not accept under the law in effect at that time, giving rise to further correspondence.explianing how to get around that little technical problem.
Having also represented claimants in Social Security disability cases, I have only slightly more faith that any federal system of reviewing claim denials would be any better. In every case but one in which I became involved or have had any personal knowledge, admittedly a selective sample, Social Security turned down every claim, including that of a quadriplegic. All the way up the long process to the Administrative Law Judge (ALJ) level, at which every one was reversed and paid except the one where the lady admitted that she had been so nervous about the hearing that she had gone down to a well-known local establishment ‘down by the police station” and bought and used some dope.” Social Security has a twelve foot shelf of regulations, typed full size and shot down to very fine print, When I asked an ALJ if I could look at his copy, there being none within 75 miles of here, he told me he didn’t have a copy at the court or in his chambers. Another ALJ told me that they were then being pressured to deny claims, and that you needed a “white house favor” to be appointed to that job. We never could find out why a home health aide’s child, in need of a heart operation, was suddenly knocked off the federally mandated State Children’s Helth Insurance Plan, after that had been scheduled, either. We’re on Social Security and nobody has ever responded to my reports of outrageous fraud we spotted on our CMS statements, either, although I have sent copies to several people including Members of Congress. Presidents and candidates for Congress of both parties have been promising to clean up the fraud in Social Security since almost immediately after it was created in 1965. Every Presidential nominee of both parties since “9/11[01” has promised that he, and only he, could and would capture Osama Bin Laden, too.
Our Members of Congress had told us, years ago, that they had passed a law providing a solution to the problem of small businesses like my law office that couldn’t buy health insurance for love or money, but, like practically everything else both parties and their politicians ever told us, that was a big lie. We saw a steady stream of health insurance sales people, and, while “no solicitors,” or “our rattlesnake bites salespeople” signs did no good, two little words, “pre-existing conditions,” sent all of them running like their tails were on fire. Asking about mental health coverage tended to have the same effect, even without that incendiary phrase. Trust me, if you don’t violate the ADA and common decency, your employees and their family members have such pre-existing conditions.
I used to have group health insurance under periodic open-enrollment periods with the State Bar of Texas. When they switched plans and carriers, I stayed with the older plan because of some coverage it offered of particular interest and concern to me that the new one did not or covered less favorably. As soon as the opportunity to switch ended, the plan I had thus been induced or seduced into choosing to stay with, with a bigger nationally known company, changed and eliminated the coverage by which they had got me to choose to say with them. Later, I discovered that, according to them, their promise to cover 80% of the cost of a semi-private room meant $80.00 per day. Even then, you couldn’t go visit a hospital in Dallas, much less pay the cost of staying in one, for $80.00 a day, not to mention all the cute little extra charges for things like $35.00 a day rental for a traction bar that couldn’t have cost that much if you had gone to the hardware store and bought the pieces of pipe. You have no choice or negotiating power when brought to a hospital by ambulance with a fractured pelvis after a head-on collision (as a passenger). I lost even this coverage when I got sick and missed a payment.
I spent nearly two years with an insurance defense law firm early in my legal career, and have spent a lot of time since dealing with insurers and self-insured health plans, and the Insurance Commissioner’s office, professionally and for my wife and myself. Nobody even wrote the full terms of at least one of the successive self-insured plans that covered my wife’s small school district until after substantial covered events, and, guess what, they were not covered though the advertising said they would be. In one case, the insurer’s CEO testified that he had, indeed, relying on what the salesman told him, assured my client that his wife’s pregnancy and complications would be covered, only to find out later that he had been lied to—and we lost anyway because the law says the consumer has no right to rely upon what the salesman tells him. Two successive plans covering the employees of this small county simply folded their tents, sent their remaining money including premiums from the county offshore, and disappeared when they received substantial covered claims for the children of elected officials. I’ve had clients’ claims paid with insurers’ bad checks, and had to collect only $100,0000.00 of some out of the state’s insurance insolvency fund. That made me skittish, even before the agents ran out the door, when those trying to sell me group health insurance for my law office and our families either couldn’t identify the companies they were supposedly representing, or they turned out to have lousy Best’s ratings, including more than one that had only $25,000.00 capital and less surplus, and some the State Insurance Commissioner had no address for and had never heard of.
The new program won’t work any better for the self-employed and true “mom and pop” or other small businesses, , and Draconian penalties will kick in no matter how hard they try to provide coverage. Nobody involved in drafting this monstrosity has ever been a struggling small businessman or self-employed individual, and, since most who have didn’t vote for Obama and those involved in writing this bill, those who did clearly set out to punish them, just as the bill clearly does those of us on Social Security, most of whom voted against Obama, too. Of course nobody involved actually solved the health insurance problems of the approximately one in five people they admit are out of work and who nobody in either party even makes any pretense of getting, or believing that they will get, back to work in years, if ever.
McCain was right about one thing. Having your health insurance tied to your at-will job is a lousy idea. One of the several reasons for this is that, inevitably, the insurer either leaks what should be confidential medical information to your boss or flat out pressures your employer to fire you. This is even more of a problem if your employer is self-insured with respect to employee health plans because the employer has a very direct and immediate interest in getting rid of anyone who, or whose family member, does or night present a big health claim. Since, in American law, you can legally be fired for good cause, no cause at all, or an evil and malicious cause, a doctrine recently reaffirmed by the Supreme Court, proving an illegal discriminatory motive led to your termination is almost always impossible.
I’ve actually read large parts of the bills, but my verbal ability scores have fallen from the 99 3/4th all the way down to the lowly 97th percentile, I was only in the upper third of my class at Vanderbilt Law, and I only practiced and dealt with such problems from one side or the other for thirty-five years, and, while actually reading the bill revealed to me that the politicians and mainstream media, including your owners at the New York Times, had misrepresented certain parts of it of special concern to me, there are huge parts of it that nobody will ever figure out until the Supreme Court makes an arbitrary decision like it has in construing some Bankruptcy Act language with which I have more expertise, and, while certain seemingly minor things, including some misrepresented by both sides, are spelled out in excruciatingly fine detail, most of this simply grants power to an awful lot of beaurocrats to be appointed by Obama, with or without Senate confirmation, to write the actual operative language.
I’m a long-time, active, conservative Republican on most issues and opposed this bill, although there were things in it that should have been enacted years ago, and I’m afraid there is not a snowball’s chance of either repeal or substantial reform of the new PPACA health care plan. For openers, the Republicans, who did more than Obama to give the Democrats solid control of both houses of Congress and then the White House, are, despite their unity in Congress against this bill, a “house divided against itself,” ignoring the good advice and successful example of Reagan and others that made and, if followed through, should have kept the Republicans in control for a generation. Given that a solid majority of voters, and a lot of significant people who had supported Obama, now disapprove of Obama’s and the Democrats’’ performance and would not vote for them again, the various factions that had given the Republicans a majority should get together and push to regain it, but, instead, too many who should know better are doing things that can only help the other side instead of unifying and starting to rebuild.

July 11, 2012 at 12:01 am
(2) Anonymous says:

Working in a hospital for 11 years, watching ‘the system’ get bled of $$Medicare. I write Appeal Letters on our Denials as well….It’s a SICK JOKE. It’s a game of shifting $. Patient Care is Atrocious!!! It’s All About The Money Now for Managed Care and Patient Care Side….No Care At All To The Patient!! I’m ashamed to work in Health Care, patients see it, and they know WE see it too…..we all feel absolutely Trapped and ready to TEAR DOWN THE WALLS!!

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