Gil Dupré

Only a few Louisiana residents have enrolled in a federally administered program designed to help people with pre-existing conditions buy health insurance.

Thirty-one Louisiana residents had taken advantage of the program between its July 1 roll-out and Nov. 1, according to the U.S. Department of Health and Human Services. Nationwide, 8,011 people had enrolled.

“I’m not sure if we can explain the slow enrollment,” said Gil Dupré, chief executive officer of the Louisiana Association of Health Plans. “What we do know is that in Louisiana, we’ve had a high-risk pool for people with pre-existing conditions for nearly 20 years.”

The Louisiana Health Plan has around 1,700 people enrolled in two different programs.

Dupré said the Louisiana Health Plan does a good job of offering coverage to people with pre-existing conditions.

The high-risk pool also does a good job of making the public aware of the program by promoting it and through contact with private insurance agents and companies, he added.

“I would think that most of the people who need that type of coverage through that type of entity are enrolled in Louisiana Health Plan,” Dupré said. “I think we always wondered who the people were who would take advantage of the federal program.”

The Pre-existing Condition Insurance Plan is part of the Obama administration’s healthcare reform package. The plan provides coverage for people who haven’t had health insurance for at least six months and who have been denied coverage by a private insurer because of a pre-existing condition.

The plan is a temporary measure designed to carry members to 2014, when insurance companies will be prohibited by law from denying coverage to people with pre-existing conditions, such as asthma, cancer and diabetes, according to HHS.

The cost for coverage under the plan is also much closer to what a healthy person would pay for health insurance, according to HHS. Premiums in state high-risk pools average 140 percent of standard rates.

Around 821,000 Louisiana residents have a diagnosed pre-existing condition that could lead to a denial of coverage by private insurers, according to a report by Families USA, a nonprofit consumer advocacy group. It’s unclear how many of those people would qualify for the Pre-Existing Condition Insurance Plan.

Regardless, enrollment in the $5 billion, federally administered plan remains far below some earlier estimates of the demand for the temporary program.

The Centers for Medicare & Medicaid Services had estimated that if there were no funding limits on the program and it were fully implemented in 2010, 375,000 people would enroll.

In June, the Congressional Budget Office estimated that if the funding cap were lifted, 400,000 people nationwide would enroll by 2011, with as many as 700,000 people enrolling by 2013. However, CBO officials said the numbers could vary widely depending on the eligibility rules, benefits and premiums.

The low enrollment numbers have given opponents of healthcare reform more ammunition. A Wall Street Journal opinion piece slammed the program, saying the pre-existing condition plan had flopped “despite generous benefits and taxpayer subsidies” that offset at least 65 percent of the total cost.

“It may turn out that there’s not nearly so much demand for that type of population as was once thought,” Dupré said.

However, HHS officials say similar programs have taken six months to a year to get off the ground. The State Children’s Health Insurance Program, which helps insure children from lower- and middle-income families, had a similar start.

In addition, marketing efforts have been complicated by the target population for the pre-existing condition plan, according to the agency. Most people don’t have pre-existing conditions and haven’t been uninsured for six months so a broad-based media campaign isn’t guaranteed to reach the program’s target audience.

HHS is working on outreach programs through the Social Security Administration and medical groups that are in regular contact with the patients that qualify for the program.

The HHS-Social Security Administration collaboration includes:

■ Posting pre-existing condition program details on the Social Security website so that people seeking disability benefits information will learn about the PCIP option.

■  Putting PCIP information on Social Security TV so that people in Social Security Administration waiting rooms will be advised about the program.

■ Having the Social Security Administration’s 150 full-time spokespeople talk about the availability of PCIP to local groups.

The agency said it is also working with states, consumer groups, chronic disease organizations, healthcare providers, social workers, other federal agencies and the insurance industry to promote PCIP to those that have been denied insurance coverage. 

In the meantime, HHS officials say the agency is trying to direct as many people, regardless of whether they have pre-existing conditions, to the HHS website, healthcare.gov.

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