CONGRESSWOMAN EDDIE BERNICE JOHNSON APPLAUDS THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES FOR TAKING STEPS TOWARDS REDUCING PREMIUMS FOR TEXAS RESIDENTS WITH PRE-EXISTING CONDITIONS

Washington, DC – (Tuesday, May 31, 2011) – The U.S. Department of Health and Human Services (HHS) announced today new steps to reduce premiums and make it easier for Americans to enroll in the Pre-Existing Condition Insurance Plan (PCIP) in Texas. PCIP is a new program created by the Affordable Care Act to help uninsured people with a pre-existing condition get high quality care at affordable prices and serves as a bridge to 2014 when insurers will no longer be allowed to deny coverage to people with any pre-existing condition, like cancer, diabetes, and asthma.

 “The Pre-Existing Condition Insurance Plan changes lives, and in many cases, literally saves lives,” said HHS Secretary Kathleen Sebelius.  “We need to reach more people and these changes help us do that.”

 Premium prices in Texas for PCIP dropped by 23.6%.  Now a 50 year old in Texas can get comprehensive health coverage for as low as $306 per month. These new, reduced premiums take effect July 1, 2011.

“I whole-heartedly applaud the United States Department of Health and Human Services’ recent steps to reduce premiums and make it easier for Americans to enroll in the Pre-Existing Condition Insurance Plan,” said Congresswoman Johnson. “Up to half of Americans below the age of 65 have pre-existing conditions and hopefully these new measures will increase enrollment by ensuring that the millions of Americans with pre-existing conditions, who would otherwise have a hard time obtaining coverage altogether, have access to affordable, high-quality health care.”

Not only has PCIP coverage become even more affordable, but enrolling is even easier.  Starting July 1, 2011, residents of Texas applying for coverage in the Federally-administered PCIP can prove their pre-existing condition simply by providing a letter from a doctor, physician assistant, or nurse practitioner dated within the past 12 months stating that they have or, at any time in the past, had a medical condition, disability, or illness.  This option became available to children under age 19 in February, and we are extending this pathway to all applicants regardless of age.  Applicants will no longer have to wait on an insurance company to send them a denial letter.  Applicants will still need to meet other eligibility criteria.

PCIP provides comprehensive health coverage, including primary and specialty care, hospital care, prescription drugs, home health and hospice care, skilled nursing care and preventive health and maternity care.  It limits annual out-of-pocket spending and does not carve out benefits the people need. Texans enrolled in PCIP have access to a provider network that includes 47,540 physicians, 4,405 pharmacies and 579 hospitals throughout the State.

 To qualify for this program, a person applying for coverage must be: a U.S. citizen or residing here legally; have been without health coverage for at least 6 months before applying; and have a pre-existing condition or have been denied coverage because of a health condition.  Eligibility is not based on income and enrollees are not charged a higher premium because of a medical condition.

To further enhance the program, beginning this fall, HHS will begin paying agents and brokers for successfully connecting eligible people with the PCIP program.  This step will help reach those who are eligible but un-enrolled.  Several States have experimented with such payments with good success.  This is a part of continuing HHS outreach efforts with States, insurers, providers, and agents and brokers to reach more eligible people and let them know that coverage is available.  HHS is also working with insurers to notify people about the PCIP option in their State when their application for health insurance is denied.

To find a chart showing changes to PCIP premiums in the States with Federally-administered PCIP programs, visit www.HealthCare.gov/news/factsheets/pcip05312011a.html.

 For more information, including eligibility, plan benefits and rates, and how to apply, visit www.pcip.govand click on “Find Your State.”  Then select Texas from a map of the United States or from the drop-down menu.  The PCIP Call Center is open from 8 a.m. to 11 p.m. Eastern Time. Call toll-free 1-866-717-5826 (TTY 1-866-561-1604).

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U.S. Representative Eddie Bernice Johnson is Ranking Member of the House Committee on Science, Space and Technology. She is also the highest-ranking Texan on the House Committee on Transportation & Infrastructure. She represents the 30th Congressional District of Texas that includes Downtown Dallas, Fair Park, Oak Lawn, Turtle Creek,Old East Dallas, Pleasant Grove, & South Oak Cliff; all of Balch Springs, DeSoto, Hutchins, Lancaster & Wilmer and parts of Cedar Hill, Duncanville, Ferris, Glenn Heights and Ovilla.