Health Subcommittee Hears from Patient Recently Denied Access to Obamacare's Pre-Existing Condition Insurance Program

April 3, 2013

WASHINGTON, DC – The Subcommittee on Health, chaired by Rep. Joe Pitts (R-PA), today discussed how to provide health care coverage options for individuals with chronic conditions and diseases and examined current challenges to this important goal. The Obama administration initially promised vulnerable Americans would be helped through 2014 by a temporary program that “makes health coverage available and more affordable for individuals who are uninsured and have been denied health insurance because of a pre-existing condition.” However, the administration recently announced individuals seeking assistance would be barred from enrolling in Pre-Existing Condition Insurance Program (PCIP) because of financial constraints even though the plan had a lower than expected enrollment.

At today’s hearing, Chairman Pitts stated, “During the last several years, there have been few areas of agreement between Republicans and Democrats on how our health care system should be reformed to better serve patients. From the beginning, however, one area that both sides have designated as a top priority is coverage for those with pre-existing conditions. In the Republican alternative to Obamacare, we proposed $25 billion over 10 years to aid Americans suffering from pre-existing conditions through new universal access programs that reformed and expanded state based high-risk pools and reinsurance programs. Obamacare, unfortunately, provided only $5 billion in its Pre-Existing Condition Insurance Plan for this purpose until January 1, 2014.”

Members heard personal testimony from one individual who was denied access to PCIP. Susan Zurface, who suffers with Chronic Lymphocytic Leukemia, testified, "Without my newly diagnosed illness, I was unable to find any health insurance coverage that would cost less than $350/month with a $10,000 deductible. It was during that research that I came across, in late February, the Ohio High Risk Pool program, offering medical coverage for $250/month with a $2,500 deductible for people with pre-existing conditions. I contacted the insurance company directly and spoke about the coverage. I printed off the application and sent it to my local oncologist for certification. I received it back and was prepared to mail it in, when I learned that the program was no longer accepting new patients due to lack of funding. My options are limited."

Ohio Lt. Governor Mary Taylor explained that the health care law's mandates have taken power away from states in managing insurance and high-risk pools. “Over the years Ohio has taken advantage of state regulated insurance – a right all other states have had prior to the ACA – in order to address our individual market and our consumers. Unfortunately, states will no longer have the ability to make decisions based on the needs of their consumers and their job creators.” She added, “Pre-ACA several states had high risk pools in place to address the needs of individuals with preexisting conditions. However, implementing them as mandated in the ACA has been problematic and eventually bankrupted the program.”/p>

AEI Fellow Thomas Miller commented, "Basically, the PCIP provisions in the ACA were drafted as a politically cosmetic afterthought. They were poorly designed and underfunded, because they were seen as little more than a temporary, tenuous bridge to a far grander political scheme for a radically reshaped set of health insurance arrangements (beginning in January 2014)."

In a recent letter to President Obama, Energy and Commerce Committee Chairman Fred Upton (R-MI), Health Subcommittee Chairman Pitts, and subcommittee Vice Chair Michael C. Burgess, M.D. (R-TX), along with House GOP leadership, recommended the transfer of funds from other programs in the health care law to PCIP to help sick Americans. The members wrote, “…while we still believe that our alternative would have provided better care and access for our most vulnerable Americans, it is time to temporarily set aside those differences and provide the resources necessary to assist those who need it most.”

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