Filed Under:Your Practice, Regulatory

Why Is the Federal Risk Pool Program So Costly?

Many PCIP enrollees have conditions such as cancer. (National Cancer Institute Photo)
Many PCIP enrollees have conditions such as cancer. (National Cancer Institute Photo)

One of the most popular components of the Patient Protection and Affordable Care Act -- a special health insurance program for people with health problems -- has had trouble providing coverage that sick people can afford in a sustainable way.

Jean Hall, a Medicaid researcher at the University of Kansas, and Janice Moore, a data manager at the university, have discussed the problems at the Pre-Existing Condition Insurance Plan (PCIP) program in a new report released by the Commonwealth Fund

In New Mexico, the state risk pool has a loss ratio equal to 442% of the standard-plan loss ratio. The PCIP plan has a loss ratio equal to 1,151% of the standard-plan loss ratio.

"Given the general lack of affordability of high-risk pool coverage at the individual level and the high costs of plan operation, the potential of high-risk pools as a vehicle for coverage expansion remains quite limited," the researchers said.

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Nichole Morford

Nichole Morford
Managing Editor

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