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The current administration reported the federal High-Risk medical plan, is expected to more than double the initial predictions of the Obama administration.
The Health Care law set aside $5 billion for the Pre-Existing Condition Insurance Plan (pcip.gov) plan. If you were denied coverage in the individual market and had been without coverage for 6 months you were eligible for this program.
The government actuaries predicted that each member of the Pcip plan would spend about $13,000 a year in claims. With 50,000 members they have a firm projection on claims. The average cost per member $28,994.
A snap shot of Claims for the PCIP plan.
Cancer treatment represents 27% of the pool’s costs.
Circulatory diseases represented 18.6% for the cost
Rehabilitative care was 18%
Degenerative Joint Disease 14.4%
The average age of the members is 55
The Obama administration goal was to have 375,000members to the PICP plan by the end of 2010.
There are states that do not have high risk pools so this plan has saved lives.
With the PCIP plan there is no waiting period for coverage. So a member could get on that plan and have an immediate surgery. This is what is referred to as guaranteed issue. In 2014 there will be guaranteed issue inside and outside the exchange. If the government actuaries were this far off on claims predication for the PCIP how far off are they on the entire health care reform?
