White House To Avert Coverage Gap for Some Americans With Pre-Existing Conditions

Dec 12, 2013 6:17pm

In a nod to the challenges that many Americans are facing in the transition to new health plans under the Affordable Care Act, the White House today announced some modest steps to provide relief for particularly at-risk consumers.

The more than 85,000 Americans who are currently enrolled in the federal Pre-Existing Condition Insurance Plan (PCIP) will now have until Jan. 15 to purchase a plan through the exchange, if they have not already done so.

“We don’t want these folks to experience a coverage gap,” said HHS Secretary Kathleen Sebelius on a conference call. There has been growing concern of late that many people with pre-existing conditions who have had difficulty signing up could see disruptions in their care come Jan. 1.

Health and Human Services says the government will foot the bill for an additional month of PCIP coverage to ensure that those 85,000 with medical conditions will continue to get benefits through Jan. 31, 2014. (The $4.74 billion program is set to expire at the end of the year, but officials said there were enough remaining funds to cover the extension.)

No immediate fix, however, for Americans outside that plan.

Republicans cast the move as yet another sign that the law is disruptive for those who are already receiving good medical care. “How many extensions and waivers is it going to take for the administration to admit the consequences of Obamacare that are hitting millions of Americans they promised it would help?” asked Senate Minority Leader Mitch McConnell in a statement.

HHS said other consumers who may have faced difficulty enrolling by Dec. 23 due to lingering technical errors on the website may be eligible for a “special enrollment period” — essentially more time to sort out their issues and sign up.  But the process of appealing for and getting granted that relief is not immediately clear.

Meanwhile, cognizant of complaints about cost and coverage changes that have been rolling in thanks to the ACA, the White House today said it is publicly encouraging insurers (but not requiring them) to be more accommodating.

The administration is asking the insurance companies to voluntarily:

— Extend the enrollment period, allowing people who miss the Dec. 23rd deadline to still qualify for coverage on Jan. 1 retroactively.

— Accept late premium payments, allowing people who pay only part of their first month premium to still get full coverage.

— Honor a consumer’s doctor choice and prescriptions from a previous plan that aren’t covered under their new plan, at least through January.

“We strongly encourage insurers to adopt these types of mitigation strategies,” said Michael Hash, director of the HHS office of health reform.

But insurers aren’t leaping at the new “recommendations” to help consumers. America’s Health Insurance Plans (AHIP) says the new guidance could “exacerbate the challenges” at hand.

In a statement AHIP and President and CEO Karen Ignagni addressed the latest regulatory guidance: “Helping consumers obtain the secure, affordable coverage they need is health plans’ top priority. With only weeks to go before coverage begins, continued changes to the rules and guidance could exacerbate the challenges associated with helping consumers through the enrollment process. Health plans will continue to do everything they can to protect consumers from potential coverage disruptions caused by the ongoing technical problems with healthcare.gov.”

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