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Administration Announces Extension of Health Care Law Program for Sick

By Melissa Attias, CQ Roll Call

December 12, 2013 -- The Obama administration announced last week that it is extending a temporary high-risk pool program created in the health care law for one month for some individuals.

The extension appears to acknowledge concerns that those patients would not have enough time to enroll in coverage through the new insurance exchanges by the program's Jan. 1 expiration date, particularly with the rocky rollout of

According to the Centers for Medicare and Medicaid Services (CMS), those who are currently enrolled in the Pre-Existing Condition Insurance Plan (PCIP) but do not yet have other coverage will now have the option of staying in the high-risk pool plan for the month of January.

The program was intended to serve as a bridge to provide coverage for individuals who faced difficulties securing health insurance due to pre-existing conditions until certain provisions of the health care law (PL 111-148, PL 111-52) took effect in 2014. Starting Jan. 1, the law prohibits insurers from denying coverage or charging higher premiums due to health status.

But House Energy and Commerce Committee Chairman Fred Upton said that Health and Human Services (HHS) Secretary Kathleen Sebelius did not mention this change or any others announced last week when asked about upcoming delays at a recent hearing.

"Unfortunately, withholding information from the public has become the norm," the Michigan Republican said in a statement.

"The administration has known for many months that this law was not ready for prime time, and Americans who depend on high-risk pools would have been better served by the administration admitting their failures sooner and working with the Congress to protect these and other Americans being harmed by the health care law," he added.

The program has served more than 135,000 people, CMS said, and offers security to some of the nation's sickest patients.

"Today, as part of our efforts to smooth the transition to the Marketplaces for those seeking coverage that begins in January, we are taking steps to ensure that Americans enrolled in the federal PCIP insurance plan will not face a lapse when the new year begins," said CMS spokesman Aaron Albright, in an email. "We are committed to providing consumers additional flexibilities while they evaluate and select a quality, affordable, health plan that meets their needs."

But Senate Minority Leader Mitch McConnell pounced on the announcement as "a clear admission that Obamacare is failing Americans with preexisting conditions who are losing the plans they already had." He said that millions of people were kicked off of their plans, but that "only a fraction of that number" have successfully signed up on the exchanges.

"How many extensions and waivers is it going to take for the administration to admit the consequences of Obamacare that are hitting millions of Americans they promised it would help?" the Kentucky Republican said in a statement.

Although the 2010 overhaul says that the program will end on Jan. 1, 2014, CMS noted that it also gave federal officials the authority to extend the coverage beyond 2013 in order to avoid a lapse in coverage for those who are transitioning to plans on the exchanges. Avoiding that lapse is important, CMS said, because many enrollees are receiving regular treatments for cancer, diabetes and other diseases.

Chris Hansen, president of the American Cancer Society Cancer Action Network, echoed that sentiment in a statement praising the decision.

"Extending the PCIP will give tens of thousands of people with a history of cancer or another serious disease the security of knowing they will not face a costly gap in coverage on Jan. 1 if they cannot enroll in a marketplace plan by Dec. 23," Hansen said. "People living with a chronic disease such as cancer must carefully weigh several factors when choosing a health plan, including premiums and other out-of-pocket costs, coverage of necessary care including prescription drugs, and available financial assistance options. Extending coverage under PCIP gives patients valuable additional time to select the marketplace plan that best meets their unique needs."

The National Association of State Comprehensive Health Insurance Plans (NASCHIP), which had previously urged an extension through March, also applauded the move in a statement. The group represents state high risk pools, including some that were administering the federal program.

"The challenges with have been particularly troubling for those high risk members who may be premium subsidy eligible but would have been forced to enroll by December 23rd to avoid a lapse in coverage," said NASCHIP President Tanya Case. "Many of these members are medically fragile and high utilizers of medical care and some are in the midst of critical treatment that cannot and should not be interrupted."

Case also noted that her group plans to work with HHS to closely monitor the situation and will once again call for a longer extension if problems continue.

CMS said it will continue to look for other ways to make the transition to the exchanges easier for all consumers, including those in the federal high-risk pool program. The agency also noted that some state programs are considering a similar extension.

Although Republicans have been working to repeal the health care law, House GOP leaders sent a letter to President Barack Obama in March asking him to support moving funds within the overhaul to cover continued enrollment in the federal high-risk pool program. The letter came after the administration announced in February that it was halting enrollment, citing cost concerns.

House Republicans went on to try to advance legislation (HR 1549) that would have taken about $3.7 billion from the health care law's prevention fund and funneled that money toward continued enrollment. But some Republicans and conservative groups expressed opposition to the legislation, arguing that it would extend and not repeal the president's signature law, and it was pulled from the House floor in April.

Although the legislation was later reworked in an attempt to address those concerns, sponsor Joe Pitts, R-Pa., said in July that the revised version also lacked the necessary votes and it was never brought back to the floor. The updated language would have completely repealed the prevention fund and provided funding for state-run high-risk pools rather than the health care law's program.

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