U.s. Government Accountability Office
Published: 2017-08-17
Total Pages: 44
Get eBook
"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..."