The winning talking point of the Obamacare mandate was that people with pre-existing conditions could not be dropped from coverage or denied coverage for health care. describes each disease or condition a person diagnosed has resulted in an individual’s insurance was dropping their coverage or denial. As a result, the Government created the Pre-existing Condition Insurance Program (PCIP), a transition program, that people with pre-existing conditions shall be provided with health care insurance now and easily transfered over to the Patient Protection and Affordable Care Act when it becomes fully implemented in 2014. That way people have health care coverage instead of people being stranded in a no health care no man’s land until 2014.

PCIP is administered by either the federal or state government but isn’t necessarily apart of a federal or state exchange (There are only 17 states with a state run exchange). If run by the state, the “State will operate a new high-risk pool alongside an existing state high-risk pool, establish a new high-risk pool (if the state does not currently have one), build upon other existing coverage programs designed to cover high-risk individuals, or contract with current HIPAA insurance carriers or insurers of last resort to provide subsidized coverage.” Currently, 27 states provide PCIP coverage. State PCIP providers will suspend their program March 2nd.

If the PCIP is administered by the federal government, the Department on Health and Human Services runs the coverage program. This federal program started off with $5 billion dollars in 2010 and has officially closed in February! The current fund can only pay for those already enrolled, and the government can no longer accept anymore applicants. As the National Review Reports, “The average cost per enrollee in 2012 was $32,108 a year. But the costs varied widely by state, from a low of $4,276 per enrollee to a high of $171,909, and some patients have annual claims as high as $225,000 per person.” breaks down by state those people who are covered by PCIP. has estimated that 110,888 people have been enrolled in PCIP. Ten months from the full implementation of Obamacare, it is now estimated that at least 40,000 people with pre-existing conditions will be dumped off into the land of misfit toys….unless….

Members of the government have introduced another bill, Helping Sick Americans Now Act (H.R. 1549). This bill will solve the current federal government’s problem by the best way government knows how. Their plan? Rob a different fund to supply the broke one.

“Notwithstanding any other provision of this section, the Secretary shall transfer amounts that are in the Fund that are attributable to fiscal year 2013 that are not otherwise obligated as of the date of the enactment of this sentence and funds that would otherwise be made available to the Fund for fiscal year 2014, fiscal year 2015, and fiscal year 2016 to the account within the Department of Health and Human Services that provides for funding to carry out the temporary high risk health insurance pool program under section 1101 and such funds shall become available for obligation under such section on such date of enactment and remain so available through December 31, 2013.”

There is bipartisan support for the Helping Sick Americans Now Act. Both sides of the aisle are hoping this passes so those promised health care coverage can be accepted in the transition program. Yet some Conservatives are hailing this bill for ulterior motives. Maybe my use of the word ‘rob’ is too harsh. Their belief is that if they transfer money from other pet projects of the Obamacare mandate to PCIP for the years 2014-2016, that will help defund the program altogether. That way the next option is to rob another program of Obamacare to fund the next broken one.

The CBO estimates that this would remove money far past 2016.

“Under current law, $1 billion per year has been provided to the PPHF for fiscal years 2013 through 2017. (In later years, that amount increases gradually to $2 billion per year.) H.R. 1549 would direct the Secretary of HHS to transfer any unobligated amounts from that fund for fiscal years 2013 through 2016 to help carry out the PCIP program. CBO estimates that about $3.7 billion of those funds would be available after accounting for the effects of sequestration under the Budget Control Act of 2011. (Following procedures under that act, $51 million of the funds for the PPHF (Prevention and Public Health Fund) were cancelled in 2013, and CBO estimates that an additional $210 million will be cancelled in fiscal years 2014 through 2016.) In addition, assuming enactment of H.R. 1549 in the spring of 2013, an estimated $0.1 billion of 2013 funds will already be obligated before such enactment.1 Thus, CBO estimates that enacting the legislation would transfer a total of $3.6 billion out of the fund, and thus decrease direct spending under the PPHF by $3.6 billion over the 2013-2023 period.”

If PCIP has already exhausted its funds, maybe the Medicaid expansion was well thought out. Since it is only to be funded until 2016, maybe the federal government already expects it to go bankrupt too which is why they put the states on the hook. The average PCIP covered person costs $32,108 a year. The medicaid expansion estimates the average person to cost $15,000. The percentage of those estimated to be in the medicaid program may also be in a high risk pool. The average cost per person may not be accurately calculated.

The Kaiser Foundation states that those eligible for medicaid suffer from a variety of preventable conditions. “Silent health problems, such as hypertension and diabetes, often go undetected without routine checkups. Uninsured nonelderly adults, compared to those with coverage, are far less likely to have had regular preventive care, including blood pressure, cholesterol checks, and cancer screenings. Consequently, uninsured patients have increased risk being diagnosed in later stages of diseases, including cancer, and die earlier than those with insurance.” These health problems make up the same insurance pool that covered patients were dropped from in the private market.

If 40,000 people have been dumped to the way side under the PCIP transition, expect the Medicaid expansion to suspend enrollment before all those eligible can enroll.

Kelli Sladick

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