The  enrollment of the subsidized health insurance program for pre exisiting health conditons (PCIP), one measure to offer affordable health insurance in Santa Monica  and the rest of  California, falls still short of expectations. After its first anniversary, there are approx. 5000 members, where as the target for membership enrollment was planned to be an  annual average of 25,000 new members.

Although PCIP premium have been lowered twice in this year, and the premium are now considerably lower than the state’s longtime Managed Risk Medical Insurance Program (MRMIP) , the enrollment is still low.

I am not surprised about it, as the main hurdle for the enrollment is the rule to be 6 months without insurance. On a daily basis I meet 55- 64 year clients, who have pre existing conditions, take expensive medication and need to have consistent medical care. How can I advise them, in good faith, to be without insurance for 6 months in order to enroll for the PCIP program. This shows exactly how great governmental programs are.

“The-6-months-without-insurance rule” was purposely implemented, so that the program would not be swamped with application of people who are loosing cobra coverage and  people, who received a premium insurance upgrade due to health conditions.  Many 55- 64 year old have in the last years lost employment, they were able to hold on their insurance due to the Cobra Subsidies, now many clients come off Cobra and because of their health conditions cannot afford to be without health insurance. As an alternative to PCIP , the private insurance companies offer HIPPA plans, guaranteed issued plans, without  the underwriting department reviewing the applicant health conditions. The premium are high but it offers continious health coverage. Patients who are chronical ill, for example with cancer, heart problems,  diabetes, asthma and  depression cannot afford to be 6 months without health insurance.

The MRMIP program is the only insurance program in the State who has a annual limit of $ 75,000. With the health care refom all private insurance have unlimited coverage. The MRMIP program  should not be even on the market as it is not health care reform. But I guess governmental program do not have to follow the health care reform law. To ask unhealthy people to be without health insurance for 6 months, makes absolutely no sense.

We as agent are experiencing the frustration of the unhealthy applicants to find affordable health insurance in California on a daily basis , and I wish someone in Sacramento would have to tell a cancer patients that he has to be without insurance for 6 months in order to apply for the PCIP program. Let’s see, what kind of rules the health care exchanges will bring in 2014, I just hope there still will be affordable health insurance  in Santa Monica and the rest of  California.