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HHS issues statement clarifying abortion coverage in Pre-Existing Condition Insurance Plans

Posted on July 15, 2010 | No Comments

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Department of Health and Human Services spokesperson Jenny Backus has released the following statement clarifying abortion coverage in the Pre-Existing Condition Insurance Plans:

As is the case with FEHB plans currently, and with the Affordable Care Act and the President’s related Executive Order more generally, in Pennsylvania and in all other states abortions will not be covered in the Pre-existing Condition Insurance Plan (PCIP) except in the cases of rape or incest, or where the life of the woman would be endangered.

Our policy is the same for both state and federally-run PCIP programs. We will reiterate this policy in guidance to those running the Pre-existing Condition Insurance Plan at both the state and federal levels. The contracts to operate the Pre-existing Condition Insurance Plan include a requirement to follow all federal laws and guidance.

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The Department of Health and Human Services (HHS) Secretary Kathleen Sebelius today announced that the Affordable Care Act's (ACA's) Pre-Existing Condition Insurance Plan (PCIP) program is providing insurance to nearly 50,000 people with high-risk pre-existing conditions nationwide. HHS released a new report demonstrating how PCIP is helping to fill a void in the insurance market for consumers with pre-existing conditions who are denied insurance coverage and are ineligible for Medicare or Medicaid coverage.
The U.S. Government Accountability Office (GAO) has issued a report comparing the early stages of the federal Pre-Existing Condition Insurance Plan (PCIP) with the Children's Health Insurance Program (CHIP). The federal PCIP was authorized by the Affordable Care Act (ACA), and is intended to provide insurance for individuals with previously existing medical conditions who have been unable to obtain health insurance coverage for at least 6 months. GAO was tasked by the Senate with comparing early enrollment and implementation across both PCIP and CHIP. GAO found that like CHIP, enrollment in PCIP was slow in the beginning, but increased over time. GAO also found that enrollment in PCIP was generally lower in States that had high risk pools than in States that did not. For more information on pre-existing conditions, click here.
The Affordable Care Act appropriated $5 billion to create the Pre-Existing Condition Insurance Plan (PCIP) program, which provides insurance for such individuals until new protections take effect in 2014. 27 states opted to run their own PCIPs, while 23 states and the District of Columbia opted to let the Department of Health and Human Services (HHS) run the PCIPs for their residents. Through their study "Pre-Existing Condition Insurance Plans: Program Features, Early Enrollment and Spending Trends, and Federal Oversight Activities," the U.S. Government Accountability Office (GAO) examined 1) PCIP features, premiums, and criteria for demonstrating a pre-existing condition, 2) trends in PCIP enrollment and spending, including administrative costs, and 3) federal oversight activities. The GAO found that state and federally run PCIPs generally had similar cost sharing arrangements. Coverage limits were common but varied, both in terms of the benefits affected and the extent of the limits. Monthly premiums ranged considerably and were generally higher in the federally run PCIP. Enrollment and spending for state and federally run PCIPs have been significantly lower than initial projections. Spending was also lower than anticipated.
A previous Implementation Brief reviewed the provisions of Affordable Care Act (ACA) that restrict the use of federal funds for insurance coverage of abortion services. The ACA prohibits federal funds from being spent for coverage that includes abortion in the individual and group health plans sold in state Exchanges and it requires plans participating in an Exchange that offer abortion coverage to collect a separate premium from beneficiaries for that coverage and to pay for abortion-related services out of those segmented funds.
The health reform law establishes restrictions on abortion coverage in the case of individual and group health plans sold in state exchanges.
Provides funding for a temporary high-risk health insurance pool for individuals with pre-existing conditions.