Legislation Aims to Protect Chronically Ill

Patients at high risk — including those with cancer, diabetes, and cardiovascular disease — will be covered under the Pre-Existing Condition Insurance Plan (PCIP) until March 31, thanks to a decision this week from the Department of Health and Human Services.

The PCIP program was originally due to end on December 31, 2013 based on the concept that plans under the Affordable Care Act would no longer exclude participants with pre-existing conditions from coverage. The Obama administration said it would extend the program to ensure high-risk consumers were covered, especially because of the frustrations with Healthcare.gov as well as other missteps in the exchange plan rollout.

"Today's announcement ensures that people with pre-existing conditions such as a history of cancer have life-saving coverage under the Pre-Existing Condition Insurance Plan through the end of open enrollment," said Steve Weiss, senior director, communications and media advocacy for the American Cancer Society Cancer Action Network, Inc. "The extension gives cancer patients and others who had no health insurance options before enrolling in PCIP extra time to choose a marketplace plan that works best for them and their families."

A bill pending lawmaker submission could also help the chronically ill, especially those enrolled in Medicare. Senator Ron Wyden of Oregon and 3 other Congressional leaders said that the Better Care, Lower Cost Act of 2014 would complement the Accountable Care Organization (ACO) model. Unlike an ACO, the Better Care Program (BCP) would allow providers to actively target and enroll the sickest patients. BCPs would also allow providers to tailor plans to patients’ individual needs and conditions.

In 2010, an estimated 70% of Medicare beneficiaries suffered from 2 or more chronic conditions which accounted for nearly 93% of Medicare spending.

In June, Senator Wyden presented at the ACO Summit in Washington, DC. He said, “Washington has been stuck for ages in tired, circular Medicare debates about increasing premiums on the wealthy and raising the age of eligibility. Those are important issues. They do not, however, reform the healthcare delivery system for the sickest seniors. That ought to be a priority for the days ahead.”

Around the Web

Program to Cover Major Illnesses Is Extended [The NY Times]

Bill Would Encourage Team-based Care for Medicare's Chronically Ill [Modern Healthcare]