Bridge Program a Lifeline For 'Medically Uninsurable'

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SAN FRANCISCO -- After undergoing emergency brain surgery in November 2010 to drain fluid that doctors believed was being caused by a tumor, Erica Chain cut short her stay in Asia where she had been doing volunteer work and returned to California where she hoped to continue her medical care.

Sorry, she was told by every health insurance company she contacted, you are “medically uninsurable” because of your pre-existing condition.

“Being 27, diagnosed with a life-threatening brain tumor and denied coverage was the lowest I ever felt,” Chain, now 29, recalled.  

But before long, Chain found out through a friend about a federally funded program administered by California, which grew out of the 2010 Affordable Care Act (ACA). The program allows people like her with pre-existing health conditions to secure affordable health coverage in the insurance market place.

Called the Pre-Existing Condition Insurance Plan (PCIP), it guarantees access to insurance for United States citizens who have a pre-existing health condition and have been uninsured for at least six months. To prevent people with private health insurance from switching to the less costly PCIP, the health reform law put in the six-month requirement provision. Applicants need only show a letter from a doctor stating they have had a medical condition in the past year.

For Chain, enrolling in PCIP couldn’t have come sooner. Within days after she did, she fell into a coma and was admitted to neuro-ICU at UCSF. There, doctors performed brain surgery to remove a rare aneurysm that had burst in her midbrain, which was previously thought to be an in-active and inoperable tumor.

The young woman remained in what doctors called a “living coma” for the next two months. She was awake, but wasn’t aware of anything going on.

“I thought I was living a bad dream,” she said.

PCIP in California

Meant to be nothing more than a “bridge” program, PCIP will fold into the ACA when the federal healthcare reform  is fully implemented Jan. 1, 2014, when insurers will no longer be able to deny individuals with pre-existing conditions coverage, or charge them higher rates because of those conditions.

Since the PCIP program began in September 2010, California has consistently led the nation in the number of enrollees. As of Dec. 31, 2012, the state had an estimated 15,100 people, with Los Angeles County boasting the highest enrollment.

At 56.9 percent, white enrollees far outnumber other ethnic groups, with Asian and Pacific Islanders (API) coming in a distant second. Chain, who is of Chinese descent, is among the 9.3 percent of API enrollees.

Health care advocates have lauded the PCIP program for providing access to health care to thousands at an affordable cost. Chain said her monthly payments are about $200.

PCIP suspended

Health care advocates worry about the recent federal directive from the Centers for Medicare and Medicaid Services (CMS), that California, as well as all other states nationwide, suspend new enrollment in its PCIP program, beginning March 2. CMS, which funds PCIP, defends the move as necessary in order to ensure that there are sufficient funds available for the rest of the year to cover those already enrolled.

The Managed Risk Medical Insurance Board (MRMIB), an arm of the state’s Health and Human Services Agency, which operates California’s PCIP program, said that while it would comply with the directive, it will still enroll anyone who is enrolled in another state but moves to California.

And it will continue to screen applications submitted after March 2 to see if the individual qualifies for the state’s own high-risk pool -- the Major Risk Medical Insurance Program (MRMIP), which health advocates say is not as attractive as PCIP.

“(MRMIP’s monthly premiums) are a lot more expensive and it offers less benefits than PCIP,” pointed out Anthony Wright, executive director of Health Access, a statewide consumer health advocacy group.

“What is more egregious is that it has a $75,000 annual cap on coverage,” he added. PCIP had none.
Wright observed that if “we had a different Congress,” one more supportive of the ACA, California and other states could have asked for more money to continue enrollment in PCIP.

Chain estimates that her medical bills would have set her and her family back by about $1.3 million, forcing them into bankruptcy. That amount includes her long rehab, where she had to relearn how to walk, talk and eat on her own.

“I came out of the coma with no short-term memory and double vision,” she said.

Thanks to PCIP, she said, she has made a hundred percent recovery, which she calls nothing short of a “miracle.”

She lamented that some people who learned of her enrollment in the program from her blogs think she got a “free ride” at the taxpayers’ cost. That, she asserted, is a misconception.

“It’s just like paying for any other normal health insurance,” she said, adding: “Without it, my case would have fallen into a county hospital or charity care,” and that would have cost the taxpayers a lot of money.

Chain’s work in health care snagged her an invitation to the White House during Obama’s second inaugural. Seven other U.S. citizens who had contributed to education, energy and other areas on the President’s agenda got to meet him in the Oval Office.

As Chain received a presidential hug, she thanked Obama for saving her life.