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"Individuals applying for healthinsurance are often denied coveragedue to a pre-existing condition. ThePatient Protection and Affordable CareAct appropriated $5 billion to create atemporary pool-known as the Pre-Existing Condition Insurance Plan(PCIP) program-to provide access toinsurance for such individuals until newprotections take effect in 2014.Twenty-seven states opted to run theirown PCIPs, while 23 states and theDistrict of Columbia opted to let theDepartment of Health and HumanServices (HHS) run the PCIPs for theirresidents. Initial projections of totalenrollment varied from 200,000 to375,000, and questions have beenraised about funding, implementation,and oversight of this new program.GAO examined (1) PCIP features,premiums, and criteria fordemonstrating a pre-existing condition,(2) trends in PCIP enrollment andspending, including administrativecosts, and (3) federal oversightactivities. GAO reviewed PCIP benefitsand rates; interviewed officials fromselected state PCIPs, HHS, and theOffice of Personnel Management(OPM), which assists HHS inadministering aspects of the federallyrun PCIP; analyzed data provided byHHS and OPM; and examinedcontracts and interagency agreements.In its comments, HHS emphasized itsrecent efforts to increase enrollmentand provided technical comments,which GAO incorporated as..."
Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.
The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.
The Patient Protection and Affordable Care Act (ACA) was designed to increase health insurance quality and affordability, lower the uninsured rate by expanding insurance coverage, and reduce the costs of healthcare overall. Along with sweeping change came sweeping criticisms and issues. This book explores the pros and cons of the Affordable Care Act, and explains who benefits from the ACA. Readers will learn how the economy is affected by the ACA, and the impact of the ACA rollout.
Pre-Existing Condition Insurance Plan Program (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) The Law Library presents the complete text of the Pre-Existing Condition Insurance Plan Program (US Department of Health and Human Services Regulation) (HHS) (2018 Edition). Updated as of May 29, 2018 Section 1101 of Title I of the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act) requires that the Secretary establish, either directly or through contracts with States or nonprofit private entities, a temporary high risk health insurance pool program to provide affordable health insurance coverage to uninsured individuals with pre-existing conditions. This program will continue until January 1, 2014, when Exchanges established under sections 1311 and 1321 of the Affordable Care Act will be available for individuals to obtain health insurance coverage. This interim final rule implements requirements in section 1101 of the Affordable Care Act. Key issues addressed in this interim final rule include administration of the program, eligibility and enrollment, benefits, premiums, funding, and appeals and oversight rules. This book contains: - The complete text of the Pre-Existing Condition Insurance Plan Program (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) - A table of contents with the page number of each section
Roughly 40 million Americans have no health insurance, private or public, and the number has grown steadily over the past 25 years. Who are these children, women, and men, and why do they lack coverage for essential health care services? How does the system of insurance coverage in the U.S. operate, and where does it fail? The first of six Institute of Medicine reports that will examine in detail the consequences of having a large uninsured population, Coverage Matters: Insurance and Health Care, explores the myths and realities of who is uninsured, identifies social, economic, and policy factors that contribute to the situation, and describes the likelihood faced by members of various population groups of being uninsured. It serves as a guide to a broad range of issues related to the lack of insurance coverage in America and provides background data of use to policy makers and health services researchers.
Pre-Existing Condition Insurance Plan: Comparison of Implementation and Early Enrollment with the Children's Health Insurance Program
Pre-Existing Condition Insurance Plan Program (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition) The Law Library presents the complete text of the Pre-Existing Condition Insurance Plan Program (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition). Updated as of May 29, 2018 This interim final rule with comment period sets the payment rates for covered services furnished to individuals enrolled in the Pre-Existing Condition Insurance Plan (PCIP) program administered directly by HHS beginning with covered services furnished on June 15, 2013. This interim final rule also prohibits facilities and providers who, with respect to dates of service beginning on June 15, 2013, accept payment for most covered services furnished to an enrollee in the federally-administered PCIP from charging the enrollee an amount greater than the enrollee's out-of-pocket cost for the covered service as calculated by the plan. The PCIP program was established under Section 1101 of Title I of the Patient Protection and Affordable Care Act (Affordable Care Act). This book contains: - The complete text of the Pre-Existing Condition Insurance Plan Program (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition) - A table of contents with the page number of each section