Alicia Ault

The Centers for Medicare and Medicaid Services on May 26 proposed modifying the rules for e-prescribing so more physicians could claim exemptions from the criteria and therefore avoid being penalized in 2012.

In a conference call with reporters, agency officials said the change-up in the e-prescribing program was in response to indications from providers and professional societies that many prescribers might not be able to meet the requirements of the current incentive program.

"Today’s rule demonstrates that CMS is willing to work cooperatively with the medical professional community to encourage participation in electronic prescribing," Dr. Patrick Conway, chief medical officer at CMS and director of the agency’s Office of Clinical Standards and Quality, said in a statement.

"These proposed changes will continue to encourage adoption of electronic prescribing while acknowledging circumstances that may keep health professionals from realizing the full potential of these systems right away," he said.

Under the current incentive program, which was established in the Medicare Improvements for Patients and Providers Act of 2008, eligible prescribers were due to get a 1% bonus payment for 2011 and 2012 and a 0.5% bonus in 2013. For prescribers who did not meet the criteria, there would be a penalty imposed in 2012. The penalty would escalate in 2013 and 2014.

The final Medicare Physician Fee Schedule for 2011 contains exceptions to the criteria, along with two hardship exemptions. Eligible professional practices are exempt if they are in a rural area without high-speed internet access or an area without enough available pharmacies for electronic prescribing.

The proposed rule would modify the criteria. For instance, prescribers who use certified electronic health records can now claim this as a "qualified" e-prescribing system. This move was designed to more closely align the e-prescribing program with the program that offers incentives for meaningful use of electronic health records.

In addition, the proposed rule would create four additional hardship exemption categories. Eligible professionals would have to demonstrate that they have:

• Registered to participate in the Medicare or Medicaid EHR incentive program and have adopted certified EHR technology.

• An inability to electronically prescribe due to local, state, or federal law (this primarily applies to prescribing of narcotics).

• Very limited prescribing activity.

• Insufficient opportunities to report the electronic prescribing measure due to limitations on the measure's denominator.

Prescribers also would be granted an extension of the deadline, until Oct. 1, 2011, to apply for the hardship exemption.

CMS officials said that this proposal is not the final word. "This is the proposed rule, so we're looking for additional comments from stakeholders," Dr. Conway said during the briefing.

The comment period closes July 26. According to Dr. Michael Rapp, director of quality measurement at CMS, who also spoke to reporters, it will probably take until at least August to have a final rule published.

The Centers for Medicare and Medicaid Services on May 26 proposed modifying the rules for e-prescribing so more physicians could claim exemptions from the criteria and therefore avoid being penalized in 2012.

In a conference call with reporters, agency officials said the change-up in the e-prescribing program was in response to indications from providers and professional societies that many prescribers might not be able to meet the requirements of the current incentive program.

"Today’s rule demonstrates that CMS is willing to work cooperatively with the medical professional community to encourage participation in electronic prescribing," Dr. Patrick Conway, chief medical officer at CMS and director of the agency’s Office of Clinical Standards and Quality, said in a statement.

"These proposed changes will continue to encourage adoption of electronic prescribing while acknowledging circumstances that may keep health professionals from realizing the full potential of these systems right away," he said.

Under the current incentive program, which was established in the Medicare Improvements for Patients and Providers Act of 2008, eligible prescribers were due to get a 1% bonus payment for 2011 and 2012 and a 0.5% bonus in 2013. For prescribers who did not meet the criteria, there would be a penalty imposed in 2012. The penalty would escalate in 2013 and 2014.

The final Medicare Physician Fee Schedule for 2011 contains exceptions to the criteria, along with two hardship exemptions. Eligible professional practices are exempt if they are in a rural area without high-speed internet access or an area without enough available pharmacies for electronic prescribing.

The proposed rule would modify the criteria. For instance, prescribers who use certified electronic health records can now claim this as a "qualified" e-prescribing system. This move was designed to more closely align the e-prescribing program with the program that offers incentives for meaningful use of electronic health records.

In addition, the proposed rule would create four additional hardship exemption categories. Eligible professionals would have to demonstrate that they have:

• Registered to participate in the Medicare or Medicaid EHR incentive program and have adopted certified EHR technology.

• An inability to electronically prescribe due to local, state, or federal law (this primarily applies to prescribing of narcotics).

• Very limited prescribing activity.

• Insufficient opportunities to report the electronic prescribing measure due to limitations on the measure's denominator.

Prescribers also would be granted an extension of the deadline, until Oct. 1, 2011, to apply for the hardship exemption.

CMS officials said that this proposal is not the final word. "This is the proposed rule, so we're looking for additional comments from stakeholders," Dr. Conway said during the briefing.

The comment period closes July 26. According to Dr. Michael Rapp, director of quality measurement at CMS, who also spoke to reporters, it will probably take until at least August to have a final rule published.

The Centers for Medicare and Medicaid Services on May 26 proposed modifying the rules for e-prescribing so more physicians could claim exemptions from the criteria and therefore avoid being penalized in 2012.

In a conference call with reporters, agency officials said the change-up in the e-prescribing program was in response to indications from providers and professional societies that many prescribers might not be able to meet the requirements of the current incentive program.

"Today’s rule demonstrates that CMS is willing to work cooperatively with the medical professional community to encourage participation in electronic prescribing," Dr. Patrick Conway, chief medical officer at CMS and director of the agency’s Office of Clinical Standards and Quality, said in a statement.

"These proposed changes will continue to encourage adoption of electronic prescribing while acknowledging circumstances that may keep health professionals from realizing the full potential of these systems right away," he said.

Under the current incentive program, which was established in the Medicare Improvements for Patients and Providers Act of 2008, eligible prescribers were due to get a 1% bonus payment for 2011 and 2012 and a 0.5% bonus in 2013. For prescribers who did not meet the criteria, there would be a penalty imposed in 2012. The penalty would escalate in 2013 and 2014.

The final Medicare Physician Fee Schedule for 2011 contains exceptions to the criteria, along with two hardship exemptions. Eligible professional practices are exempt if they are in a rural area without high-speed internet access or an area without enough available pharmacies for electronic prescribing.

The proposed rule would modify the criteria. For instance, prescribers who use certified electronic health records can now claim this as a "qualified" e-prescribing system. This move was designed to more closely align the e-prescribing program with the program that offers incentives for meaningful use of electronic health records.

In addition, the proposed rule would create four additional hardship exemption categories. Eligible professionals would have to demonstrate that they have:

• Registered to participate in the Medicare or Medicaid EHR incentive program and have adopted certified EHR technology.

• An inability to electronically prescribe due to local, state, or federal law (this primarily applies to prescribing of narcotics).

• Very limited prescribing activity.

• Insufficient opportunities to report the electronic prescribing measure due to limitations on the measure's denominator.

Prescribers also would be granted an extension of the deadline, until Oct. 1, 2011, to apply for the hardship exemption.

CMS officials said that this proposal is not the final word. "This is the proposed rule, so we're looking for additional comments from stakeholders," Dr. Conway said during the briefing.

The comment period closes July 26. According to Dr. Michael Rapp, director of quality measurement at CMS, who also spoke to reporters, it will probably take until at least August to have a final rule published.

Research among primary care physicians has outlined "Top 5" practices to avoid in order to deliver better quality, more cost-effective medical care.

For internists and family physicians, the top item on the not-to-do list: Don’t do imaging for low back pain within the first 6 weeks unless red flags are present. For pediatricians, the top quality-promoting, cost-reducing activity is: Don’t prescribe antibiotics for pharyngitis unless the patient tests positive for streptococcus.

The recommendations were published May 23 in the Archives of Internal Medicine.

Working groups convened by the nonprofit National Physicians Alliance sought to find evidence-based activities that were common in primary care. To be included on the top 5 lists, the activities had to be lead to significant health benefits, as well as reduce harms to patients and cut health care costs.

The top 5 practices that should be adopted by internists include:

• Don’t do imaging for low-back pain within the first 6 weeks unless red flags are present.

• Don’t obtain blood chemistry panels or urinalyses for screening in asymptomatic, healthy adults.

• Don’t order annual electrocardiograms (ECG) or any other cardiac screening for asymptomatic, low-risk adults.

• Use only generic statins when initiating lipid-lowering drug therapy.

• Don’t use dual energy x-ray absorptiometry (DEXA) screening for osteoporosis in women under age 65 years or men under 70 years with no risk factors.

The top 5 not-to-do list for family physicians is similar, but not identical, and includes:

• Don’t do imaging for low-back pain within the first 6 weeks unless red flags are present.

• Don’t routinely prescribe antibiotics for acute mild to moderate sinusitis unless symptoms last for 7 days or more or symptoms worsen after initial clinical improvement.

• Don’t order annual ECG or any other cardiac screening for asymptomatic, low-risk adults.

• Don’t perform Pap tests on patients younger than 21 years or in women status post hysterectomy for benign disease.

• Don’t use DEXA screening for osteoporosis in women under age 65 years or men under 70 years with no risk factors.

For pediatricians, the top 5 quality-improving activities include:

• Don’t prescribe antibiotics for pharyngitis unless the patient tests positive for streptococcus.

• Don’t obtain diagnostic images for minor head injuries without loss of consciousness or other risk factors.

• Don’t refer otitis media with effusion early in the course of the problem.

• Advise patients not to use cough and cold medications.

• Use inhaled corticosteroids to control asthma appropriately.

Consensus lists were drawn up by working group members and tested initially with 83 NPA physicians who rated the activity based on how often they engaged in the activity in their practice, its impact on quality of care and cost, the strength of the evidence supporting the activity, and how easy or hard it was to eliminate from their practice.

Field testing then was expanded through an invitation to all NPA members. There were 172 testers in the second round, all of whom completed the same surveys as the initial testers.

Field testing showed support for the evidence that backed the recommendations, and the ease with which they could be implemented, according to the study’s authors in the Good Stewardship Working Group. However, they pointed out, field testing physicians might not be representative of all internists, family physicians, and pediatricians.

The authors pointed out that although the groups worked independently, several activities to avoid appeared on more than one list. "This commonality across specialties reinforced the importance and relevance of addressing overuse of these activities," the authors said (Arch. Intern. Med. 2011[doi: 10.1001/archinternmed.2011.231]).

However, the lists are limited in that they are the product on one particular group of physicians. A different group might have come up with a different list, they added.

Even so, the NPA plans to distribute the top 5 lists to all its members who are internists, family physicians, and pediatricians. The organization also plans to create a virtual practice community to help members implement the recommendations. And it says it will create a training video that will teach physicians how to enlist their patients’ support for the recommendations; another video will be created specifically to explain to patients the rationale behind the lists.

The NPA plans to seek endorsements from patient advocacy and patient safety groups to "help dispel the misconception that these clinical recommendations represent rationing and support the idea that often less is truly more."

The project was funded by a grant from the American Board of Internal Medicine Foundation.

Research among primary care physicians has outlined "Top 5" practices to avoid in order to deliver better quality, more cost-effective medical care.

For internists and family physicians, the top item on the not-to-do list: Don’t do imaging for low back pain within the first 6 weeks unless red flags are present. For pediatricians, the top quality-promoting, cost-reducing activity is: Don’t prescribe antibiotics for pharyngitis unless the patient tests positive for streptococcus.

The recommendations were published May 23 in the Archives of Internal Medicine.

Working groups convened by the nonprofit National Physicians Alliance sought to find evidence-based activities that were common in primary care. To be included on the top 5 lists, the activities had to be lead to significant health benefits, as well as reduce harms to patients and cut health care costs.

The top 5 practices that should be adopted by internists include:

• Don’t do imaging for low-back pain within the first 6 weeks unless red flags are present.

• Don’t obtain blood chemistry panels or urinalyses for screening in asymptomatic, healthy adults.

• Don’t order annual electrocardiograms (ECG) or any other cardiac screening for asymptomatic, low-risk adults.

• Use only generic statins when initiating lipid-lowering drug therapy.

• Don’t use dual energy x-ray absorptiometry (DEXA) screening for osteoporosis in women under age 65 years or men under 70 years with no risk factors.

The top 5 not-to-do list for family physicians is similar, but not identical, and includes:

• Don’t do imaging for low-back pain within the first 6 weeks unless red flags are present.

• Don’t routinely prescribe antibiotics for acute mild to moderate sinusitis unless symptoms last for 7 days or more or symptoms worsen after initial clinical improvement.

• Don’t order annual ECG or any other cardiac screening for asymptomatic, low-risk adults.

• Don’t perform Pap tests on patients younger than 21 years or in women status post hysterectomy for benign disease.

• Don’t use DEXA screening for osteoporosis in women under age 65 years or men under 70 years with no risk factors.

For pediatricians, the top 5 quality-improving activities include:

• Don’t prescribe antibiotics for pharyngitis unless the patient tests positive for streptococcus.

• Don’t obtain diagnostic images for minor head injuries without loss of consciousness or other risk factors.

• Don’t refer otitis media with effusion early in the course of the problem.

• Advise patients not to use cough and cold medications.

• Use inhaled corticosteroids to control asthma appropriately.

Consensus lists were drawn up by working group members and tested initially with 83 NPA physicians who rated the activity based on how often they engaged in the activity in their practice, its impact on quality of care and cost, the strength of the evidence supporting the activity, and how easy or hard it was to eliminate from their practice.

Field testing then was expanded through an invitation to all NPA members. There were 172 testers in the second round, all of whom completed the same surveys as the initial testers.

Field testing showed support for the evidence that backed the recommendations, and the ease with which they could be implemented, according to the study’s authors in the Good Stewardship Working Group. However, they pointed out, field testing physicians might not be representative of all internists, family physicians, and pediatricians.

The authors pointed out that although the groups worked independently, several activities to avoid appeared on more than one list. "This commonality across specialties reinforced the importance and relevance of addressing overuse of these activities," the authors said (Arch. Intern. Med. 2011[doi: 10.1001/archinternmed.2011.231]).

However, the lists are limited in that they are the product on one particular group of physicians. A different group might have come up with a different list, they added.

Even so, the NPA plans to distribute the top 5 lists to all its members who are internists, family physicians, and pediatricians. The organization also plans to create a virtual practice community to help members implement the recommendations. And it says it will create a training video that will teach physicians how to enlist their patients’ support for the recommendations; another video will be created specifically to explain to patients the rationale behind the lists.

The NPA plans to seek endorsements from patient advocacy and patient safety groups to "help dispel the misconception that these clinical recommendations represent rationing and support the idea that often less is truly more."

The project was funded by a grant from the American Board of Internal Medicine Foundation.

Research among primary care physicians has outlined "Top 5" practices to avoid in order to deliver better quality, more cost-effective medical care.

For internists and family physicians, the top item on the not-to-do list: Don’t do imaging for low back pain within the first 6 weeks unless red flags are present. For pediatricians, the top quality-promoting, cost-reducing activity is: Don’t prescribe antibiotics for pharyngitis unless the patient tests positive for streptococcus.

The recommendations were published May 23 in the Archives of Internal Medicine.

Working groups convened by the nonprofit National Physicians Alliance sought to find evidence-based activities that were common in primary care. To be included on the top 5 lists, the activities had to be lead to significant health benefits, as well as reduce harms to patients and cut health care costs.

The top 5 practices that should be adopted by internists include:

• Don’t do imaging for low-back pain within the first 6 weeks unless red flags are present.

• Don’t obtain blood chemistry panels or urinalyses for screening in asymptomatic, healthy adults.

• Don’t order annual electrocardiograms (ECG) or any other cardiac screening for asymptomatic, low-risk adults.

• Use only generic statins when initiating lipid-lowering drug therapy.

• Don’t use dual energy x-ray absorptiometry (DEXA) screening for osteoporosis in women under age 65 years or men under 70 years with no risk factors.

The top 5 not-to-do list for family physicians is similar, but not identical, and includes:

• Don’t do imaging for low-back pain within the first 6 weeks unless red flags are present.

• Don’t routinely prescribe antibiotics for acute mild to moderate sinusitis unless symptoms last for 7 days or more or symptoms worsen after initial clinical improvement.

• Don’t order annual ECG or any other cardiac screening for asymptomatic, low-risk adults.

• Don’t perform Pap tests on patients younger than 21 years or in women status post hysterectomy for benign disease.

• Don’t use DEXA screening for osteoporosis in women under age 65 years or men under 70 years with no risk factors.

For pediatricians, the top 5 quality-improving activities include:

• Don’t prescribe antibiotics for pharyngitis unless the patient tests positive for streptococcus.

• Don’t obtain diagnostic images for minor head injuries without loss of consciousness or other risk factors.

• Don’t refer otitis media with effusion early in the course of the problem.

• Advise patients not to use cough and cold medications.

• Use inhaled corticosteroids to control asthma appropriately.

Consensus lists were drawn up by working group members and tested initially with 83 NPA physicians who rated the activity based on how often they engaged in the activity in their practice, its impact on quality of care and cost, the strength of the evidence supporting the activity, and how easy or hard it was to eliminate from their practice.

Field testing then was expanded through an invitation to all NPA members. There were 172 testers in the second round, all of whom completed the same surveys as the initial testers.

Field testing showed support for the evidence that backed the recommendations, and the ease with which they could be implemented, according to the study’s authors in the Good Stewardship Working Group. However, they pointed out, field testing physicians might not be representative of all internists, family physicians, and pediatricians.

The authors pointed out that although the groups worked independently, several activities to avoid appeared on more than one list. "This commonality across specialties reinforced the importance and relevance of addressing overuse of these activities," the authors said (Arch. Intern. Med. 2011[doi: 10.1001/archinternmed.2011.231]).

However, the lists are limited in that they are the product on one particular group of physicians. A different group might have come up with a different list, they added.

Even so, the NPA plans to distribute the top 5 lists to all its members who are internists, family physicians, and pediatricians. The organization also plans to create a virtual practice community to help members implement the recommendations. And it says it will create a training video that will teach physicians how to enlist their patients’ support for the recommendations; another video will be created specifically to explain to patients the rationale behind the lists.

The NPA plans to seek endorsements from patient advocacy and patient safety groups to "help dispel the misconception that these clinical recommendations represent rationing and support the idea that often less is truly more."

The project was funded by a grant from the American Board of Internal Medicine Foundation.

Research among primary care physicians has outlined "Top 5" practices to avoid in order to deliver better quality, more cost-effective medical care.

For internists and family physicians, the top item on the not-to-do list: Don’t do imaging for low back pain within the first 6 weeks unless red flags are present. For pediatricians, the top quality-promoting, cost-reducing activity is: Don’t prescribe antibiotics for pharyngitis unless the patient tests positive for streptococcus.

The recommendations were published May 23 in the Archives of Internal Medicine.

Working groups convened by the nonprofit National Physicians Alliance sought to find evidence-based activities that were common in primary care. To be included on the top 5 lists, the activities had to be lead to significant health benefits, as well as reduce harms to patients and cut health care costs.

The top 5 practices that should be adopted by internists include:

• Don’t do imaging for low-back pain within the first 6 weeks unless red flags are present.

• Don’t obtain blood chemistry panels or urinalyses for screening in asymptomatic, healthy adults.

• Don’t order annual electrocardiograms (ECG) or any other cardiac screening for asymptomatic, low-risk adults.

• Use only generic statins when initiating lipid-lowering drug therapy.

• Don’t use dual energy x-ray absorptiometry (DEXA) screening for osteoporosis in women under age 65 years or men under 70 years with no risk factors.

The top 5 not-to-do list for family physicians is similar, but not identical, and includes:

• Don’t do imaging for low-back pain within the first 6 weeks unless red flags are present.

• Don’t routinely prescribe antibiotics for acute mild to moderate sinusitis unless symptoms last for 7 days or more or symptoms worsen after initial clinical improvement.

• Don’t order annual ECG or any other cardiac screening for asymptomatic, low-risk adults.

• Don’t perform Pap tests on patients younger than 21 years or in women status post hysterectomy for benign disease.

• Don’t use DEXA screening for osteoporosis in women under age 65 years or men under 70 years with no risk factors.

For pediatricians, the top 5 quality-improving activities include:

• Don’t prescribe antibiotics for pharyngitis unless the patient tests positive for streptococcus.

• Don’t obtain diagnostic images for minor head injuries without loss of consciousness or other risk factors.

• Don’t refer otitis media with effusion early in the course of the problem.

• Advise patients not to use cough and cold medications.

• Use inhaled corticosteroids to control asthma appropriately.

Consensus lists were drawn up by working group members and tested initially with 83 NPA physicians who rated the activity based on how often they engaged in the activity in their practice, its impact on quality of care and cost, the strength of the evidence supporting the activity, and how easy or hard it was to eliminate from their practice.

Field testing then was expanded through an invitation to all NPA members. There were 172 testers in the second round, all of whom completed the same surveys as the initial testers.

Field testing showed support for the evidence that backed the recommendations, and the ease with which they could be implemented, according to the study’s authors in the Good Stewardship Working Group. However, they pointed out, field testing physicians might not be representative of all internists, family physicians, and pediatricians.

The authors pointed out that although the groups worked independently, several activities to avoid appeared on more than one list. "This commonality across specialties reinforced the importance and relevance of addressing overuse of these activities," the authors said (Arch. Intern. Med. 2011[doi: 10.1001/archinternmed.2011.231]).

However, the lists are limited in that they are the product on one particular group of physicians. A different group might have come up with a different list, they added.

Even so, the NPA plans to distribute the top 5 lists to all its members who are internists, family physicians, and pediatricians. The organization also plans to create a virtual practice community to help members implement the recommendations. And it says it will create a training video that will teach physicians how to enlist their patients’ support for the recommendations; another video will be created specifically to explain to patients the rationale behind the lists.

The NPA plans to seek endorsements from patient advocacy and patient safety groups to "help dispel the misconception that these clinical recommendations represent rationing and support the idea that often less is truly more."

The project was funded by a grant from the American Board of Internal Medicine Foundation.

Research among primary care physicians has outlined "Top 5" practices to avoid in order to deliver better quality, more cost-effective medical care.

For internists and family physicians, the top item on the not-to-do list: Don’t do imaging for low back pain within the first 6 weeks unless red flags are present. For pediatricians, the top quality-promoting, cost-reducing activity is: Don’t prescribe antibiotics for pharyngitis unless the patient tests positive for streptococcus.

The recommendations were published May 23 in the Archives of Internal Medicine.

Working groups convened by the nonprofit National Physicians Alliance sought to find evidence-based activities that were common in primary care. To be included on the top 5 lists, the activities had to be lead to significant health benefits, as well as reduce harms to patients and cut health care costs.

The top 5 practices that should be adopted by internists include:

• Don’t do imaging for low-back pain within the first 6 weeks unless red flags are present.

• Don’t obtain blood chemistry panels or urinalyses for screening in asymptomatic, healthy adults.

• Don’t order annual electrocardiograms (ECG) or any other cardiac screening for asymptomatic, low-risk adults.

• Use only generic statins when initiating lipid-lowering drug therapy.

• Don’t use dual energy x-ray absorptiometry (DEXA) screening for osteoporosis in women under age 65 years or men under 70 years with no risk factors.

The top 5 not-to-do list for family physicians is similar, but not identical, and includes:

• Don’t do imaging for low-back pain within the first 6 weeks unless red flags are present.

• Don’t routinely prescribe antibiotics for acute mild to moderate sinusitis unless symptoms last for 7 days or more or symptoms worsen after initial clinical improvement.

• Don’t order annual ECG or any other cardiac screening for asymptomatic, low-risk adults.

• Don’t perform Pap tests on patients younger than 21 years or in women status post hysterectomy for benign disease.

• Don’t use DEXA screening for osteoporosis in women under age 65 years or men under 70 years with no risk factors.

For pediatricians, the top 5 quality-improving activities include:

• Don’t prescribe antibiotics for pharyngitis unless the patient tests positive for streptococcus.

• Don’t obtain diagnostic images for minor head injuries without loss of consciousness or other risk factors.

• Don’t refer otitis media with effusion early in the course of the problem.

• Advise patients not to use cough and cold medications.

• Use inhaled corticosteroids to control asthma appropriately.

Consensus lists were drawn up by working group members and tested initially with 83 NPA physicians who rated the activity based on how often they engaged in the activity in their practice, its impact on quality of care and cost, the strength of the evidence supporting the activity, and how easy or hard it was to eliminate from their practice.

Field testing then was expanded through an invitation to all NPA members. There were 172 testers in the second round, all of whom completed the same surveys as the initial testers.

Field testing showed support for the evidence that backed the recommendations, and the ease with which they could be implemented, according to the study’s authors in the Good Stewardship Working Group. However, they pointed out, field testing physicians might not be representative of all internists, family physicians, and pediatricians.

The authors pointed out that although the groups worked independently, several activities to avoid appeared on more than one list. "This commonality across specialties reinforced the importance and relevance of addressing overuse of these activities," the authors said (Arch. Intern. Med. 2011[doi: 10.1001/archinternmed.2011.231]).

However, the lists are limited in that they are the product on one particular group of physicians. A different group might have come up with a different list, they added.

Even so, the NPA plans to distribute the top 5 lists to all its members who are internists, family physicians, and pediatricians. The organization also plans to create a virtual practice community to help members implement the recommendations. And it says it will create a training video that will teach physicians how to enlist their patients’ support for the recommendations; another video will be created specifically to explain to patients the rationale behind the lists.

The NPA plans to seek endorsements from patient advocacy and patient safety groups to "help dispel the misconception that these clinical recommendations represent rationing and support the idea that often less is truly more."

The project was funded by a grant from the American Board of Internal Medicine Foundation.

Research among primary care physicians has outlined "Top 5" practices to avoid in order to deliver better quality, more cost-effective medical care.

For internists and family physicians, the top item on the not-to-do list: Don’t do imaging for low back pain within the first 6 weeks unless red flags are present. For pediatricians, the top quality-promoting, cost-reducing activity is: Don’t prescribe antibiotics for pharyngitis unless the patient tests positive for streptococcus.

The recommendations were published May 23 in the Archives of Internal Medicine.

Working groups convened by the nonprofit National Physicians Alliance sought to find evidence-based activities that were common in primary care. To be included on the top 5 lists, the activities had to be lead to significant health benefits, as well as reduce harms to patients and cut health care costs.

The top 5 practices that should be adopted by internists include:

• Don’t do imaging for low-back pain within the first 6 weeks unless red flags are present.

• Don’t obtain blood chemistry panels or urinalyses for screening in asymptomatic, healthy adults.

• Don’t order annual electrocardiograms (ECG) or any other cardiac screening for asymptomatic, low-risk adults.

• Use only generic statins when initiating lipid-lowering drug therapy.

• Don’t use dual energy x-ray absorptiometry (DEXA) screening for osteoporosis in women under age 65 years or men under 70 years with no risk factors.

The top 5 not-to-do list for family physicians is similar, but not identical, and includes:

• Don’t do imaging for low-back pain within the first 6 weeks unless red flags are present.

• Don’t routinely prescribe antibiotics for acute mild to moderate sinusitis unless symptoms last for 7 days or more or symptoms worsen after initial clinical improvement.

• Don’t order annual ECG or any other cardiac screening for asymptomatic, low-risk adults.

• Don’t perform Pap tests on patients younger than 21 years or in women status post hysterectomy for benign disease.

• Don’t use DEXA screening for osteoporosis in women under age 65 years or men under 70 years with no risk factors.

For pediatricians, the top 5 quality-improving activities include:

• Don’t prescribe antibiotics for pharyngitis unless the patient tests positive for streptococcus.

• Don’t obtain diagnostic images for minor head injuries without loss of consciousness or other risk factors.

• Don’t refer otitis media with effusion early in the course of the problem.

• Advise patients not to use cough and cold medications.

• Use inhaled corticosteroids to control asthma appropriately.

Consensus lists were drawn up by working group members and tested initially with 83 NPA physicians who rated the activity based on how often they engaged in the activity in their practice, its impact on quality of care and cost, the strength of the evidence supporting the activity, and how easy or hard it was to eliminate from their practice.

Field testing then was expanded through an invitation to all NPA members. There were 172 testers in the second round, all of whom completed the same surveys as the initial testers.

Field testing showed support for the evidence that backed the recommendations, and the ease with which they could be implemented, according to the study’s authors in the Good Stewardship Working Group. However, they pointed out, field testing physicians might not be representative of all internists, family physicians, and pediatricians.

The authors pointed out that although the groups worked independently, several activities to avoid appeared on more than one list. "This commonality across specialties reinforced the importance and relevance of addressing overuse of these activities," the authors said (Arch. Intern. Med. 2011[doi: 10.1001/archinternmed.2011.231]).

However, the lists are limited in that they are the product on one particular group of physicians. A different group might have come up with a different list, they added.

Even so, the NPA plans to distribute the top 5 lists to all its members who are internists, family physicians, and pediatricians. The organization also plans to create a virtual practice community to help members implement the recommendations. And it says it will create a training video that will teach physicians how to enlist their patients’ support for the recommendations; another video will be created specifically to explain to patients the rationale behind the lists.

The NPA plans to seek endorsements from patient advocacy and patient safety groups to "help dispel the misconception that these clinical recommendations represent rationing and support the idea that often less is truly more."

The project was funded by a grant from the American Board of Internal Medicine Foundation.

Swimmer’s ear caused an estimated 2.4 million trips to physician offices and emergency departments in 2007 and cost nearly $500 million to treat, the Centers for Disease Control and Prevention reported May 19.

The condition, also known as acute otitis externa (AOE), is easy to prevent, however – a fact the CDC is highlighting in advance of the nation’s swimming pools opening around Memorial Day weekend.

"Most people think of swimmer’s ear as a mild condition that quickly goes away, but this common infection is responsible for millions of illnesses and substantial medical costs each year," Dr. Michael Beach, associate director for healthy water at the CDC, said in a statement. "By taking simple steps before and after swimming or coming in contact with water, people can greatly reduce their risk of this painful infection," he said.

A study in the agency’s Morbidity and Mortality Weekly Report is the first to look at the national costs associated with swimmer’s ear, a common condition in which pathogens proliferate in a moist environment in the ear canal (MMWR 2011;60:605-9).

The condition occurs most often in people who are exposed frequently to water, through bathing or swimming, and also in residents of warm and humid climates. Swimmer’s ear is characterized by pain, tenderness, redness, and swelling of the external ear canal. Most cases can be treated easily with topical antimicrobials, according to a statement from the CDC.

Not surprisingly, the study showed that AOE cases peak during the summer months. A total of 44% of cases occurred during June, July, and August, noted Dr. Emily W. Piercefield of the CDC’s Division of Applied Sciences, and her colleagues.

The data showed that children aged 5-9 years accounted for the highest frequency of physician visits for AOE, at 18.6 visits/1,000 people. Children aged 10-14 years accounted for 15.8/1,000. Interestingly, adults age 20 years and older accounted for 53% of AOE-related physician visits.

Southerners had the highest frequency of visits, at 9.1/1,000. AOE cases were least frequent in the West, at 4.3/1,000. There was no difference in frequency between urban and rural residents.

The study authors obtained incidence estimates by using the CDC’s National Ambulatory Medical Care Survey for 2003-2007 and the 2007 Nationwide Emergency Department Sample. Costs were estimated through use of a commercial insurance database.

The estimated annual tally for direct health-care costs was $489 million. The average cost per case was $200 for those patients who did not require hospitalization. None of the ambulatory care patients required admission, but almost 3% of those who visited an emergency department for swimmer’s ear were hospitalized.

Health care providers spent an estimated 597,761 hours annually treating swimmer’s ear in the ambulatory-care setting, according to the study authors.

Among the prevention measures suggested by the CDC:

• Use ear plugs or bathing caps to reduce exposure of the ears to water.

• Dry the ears after swimming.

• Keep foreign objects – which could break the skin and create an avenue for infection – out of the ear.

The agency also cautioned against removing ear wax, which protects from infection. And it recommended that pool and water park operators maintain proper pH and chlorine levels to retard growth of Pseudomonas aeruginosa and Staphylococcus species, which are responsible for AOE infections.

The CDC has two websites for more information on swimmer’s ear and healthy swimming.

Swimmer’s ear caused an estimated 2.4 million trips to physician offices and emergency departments in 2007 and cost nearly $500 million to treat, the Centers for Disease Control and Prevention reported May 19.

The condition, also known as acute otitis externa (AOE), is easy to prevent, however – a fact the CDC is highlighting in advance of the nation’s swimming pools opening around Memorial Day weekend.

"Most people think of swimmer’s ear as a mild condition that quickly goes away, but this common infection is responsible for millions of illnesses and substantial medical costs each year," Dr. Michael Beach, associate director for healthy water at the CDC, said in a statement. "By taking simple steps before and after swimming or coming in contact with water, people can greatly reduce their risk of this painful infection," he said.

A study in the agency’s Morbidity and Mortality Weekly Report is the first to look at the national costs associated with swimmer’s ear, a common condition in which pathogens proliferate in a moist environment in the ear canal (MMWR 2011;60:605-9).

The condition occurs most often in people who are exposed frequently to water, through bathing or swimming, and also in residents of warm and humid climates. Swimmer’s ear is characterized by pain, tenderness, redness, and swelling of the external ear canal. Most cases can be treated easily with topical antimicrobials, according to a statement from the CDC.

Not surprisingly, the study showed that AOE cases peak during the summer months. A total of 44% of cases occurred during June, July, and August, noted Dr. Emily W. Piercefield of the CDC’s Division of Applied Sciences, and her colleagues.

The data showed that children aged 5-9 years accounted for the highest frequency of physician visits for AOE, at 18.6 visits/1,000 people. Children aged 10-14 years accounted for 15.8/1,000. Interestingly, adults age 20 years and older accounted for 53% of AOE-related physician visits.

Southerners had the highest frequency of visits, at 9.1/1,000. AOE cases were least frequent in the West, at 4.3/1,000. There was no difference in frequency between urban and rural residents.

The study authors obtained incidence estimates by using the CDC’s National Ambulatory Medical Care Survey for 2003-2007 and the 2007 Nationwide Emergency Department Sample. Costs were estimated through use of a commercial insurance database.

The estimated annual tally for direct health-care costs was $489 million. The average cost per case was $200 for those patients who did not require hospitalization. None of the ambulatory care patients required admission, but almost 3% of those who visited an emergency department for swimmer’s ear were hospitalized.

Health care providers spent an estimated 597,761 hours annually treating swimmer’s ear in the ambulatory-care setting, according to the study authors.

Among the prevention measures suggested by the CDC:

• Use ear plugs or bathing caps to reduce exposure of the ears to water.

• Dry the ears after swimming.

• Keep foreign objects – which could break the skin and create an avenue for infection – out of the ear.

The agency also cautioned against removing ear wax, which protects from infection. And it recommended that pool and water park operators maintain proper pH and chlorine levels to retard growth of Pseudomonas aeruginosa and Staphylococcus species, which are responsible for AOE infections.

The CDC has two websites for more information on swimmer’s ear and healthy swimming.

Swimmer’s ear caused an estimated 2.4 million trips to physician offices and emergency departments in 2007 and cost nearly $500 million to treat, the Centers for Disease Control and Prevention reported May 19.

The condition, also known as acute otitis externa (AOE), is easy to prevent, however – a fact the CDC is highlighting in advance of the nation’s swimming pools opening around Memorial Day weekend.

"Most people think of swimmer’s ear as a mild condition that quickly goes away, but this common infection is responsible for millions of illnesses and substantial medical costs each year," Dr. Michael Beach, associate director for healthy water at the CDC, said in a statement. "By taking simple steps before and after swimming or coming in contact with water, people can greatly reduce their risk of this painful infection," he said.

A study in the agency’s Morbidity and Mortality Weekly Report is the first to look at the national costs associated with swimmer’s ear, a common condition in which pathogens proliferate in a moist environment in the ear canal (MMWR 2011;60:605-9).

The condition occurs most often in people who are exposed frequently to water, through bathing or swimming, and also in residents of warm and humid climates. Swimmer’s ear is characterized by pain, tenderness, redness, and swelling of the external ear canal. Most cases can be treated easily with topical antimicrobials, according to a statement from the CDC.

Not surprisingly, the study showed that AOE cases peak during the summer months. A total of 44% of cases occurred during June, July, and August, noted Dr. Emily W. Piercefield of the CDC’s Division of Applied Sciences, and her colleagues.

The data showed that children aged 5-9 years accounted for the highest frequency of physician visits for AOE, at 18.6 visits/1,000 people. Children aged 10-14 years accounted for 15.8/1,000. Interestingly, adults age 20 years and older accounted for 53% of AOE-related physician visits.

Southerners had the highest frequency of visits, at 9.1/1,000. AOE cases were least frequent in the West, at 4.3/1,000. There was no difference in frequency between urban and rural residents.

The study authors obtained incidence estimates by using the CDC’s National Ambulatory Medical Care Survey for 2003-2007 and the 2007 Nationwide Emergency Department Sample. Costs were estimated through use of a commercial insurance database.

The estimated annual tally for direct health-care costs was $489 million. The average cost per case was $200 for those patients who did not require hospitalization. None of the ambulatory care patients required admission, but almost 3% of those who visited an emergency department for swimmer’s ear were hospitalized.

Health care providers spent an estimated 597,761 hours annually treating swimmer’s ear in the ambulatory-care setting, according to the study authors.

Among the prevention measures suggested by the CDC:

• Use ear plugs or bathing caps to reduce exposure of the ears to water.

• Dry the ears after swimming.

• Keep foreign objects – which could break the skin and create an avenue for infection – out of the ear.

The agency also cautioned against removing ear wax, which protects from infection. And it recommended that pool and water park operators maintain proper pH and chlorine levels to retard growth of Pseudomonas aeruginosa and Staphylococcus species, which are responsible for AOE infections.

The CDC has two websites for more information on swimmer’s ear and healthy swimming.

Swimmer’s ear caused an estimated 2.4 million trips to physician offices and emergency departments in 2007 and cost nearly $500 million to treat, the Centers for Disease Control and Prevention reported May 19.

The condition, also known as acute otitis externa (AOE), is easy to prevent, however – a fact the CDC is highlighting in advance of the nation’s swimming pools opening around Memorial Day weekend.

"Most people think of swimmer’s ear as a mild condition that quickly goes away, but this common infection is responsible for millions of illnesses and substantial medical costs each year," Dr. Michael Beach, associate director for healthy water at the CDC, said in a statement. "By taking simple steps before and after swimming or coming in contact with water, people can greatly reduce their risk of this painful infection," he said.

A study in the agency’s Morbidity and Mortality Weekly Report is the first to look at the national costs associated with swimmer’s ear, a common condition in which pathogens proliferate in a moist environment in the ear canal (MMWR 2011;60:605-9).

The condition occurs most often in people who are exposed frequently to water, through bathing or swimming, and also in residents of warm and humid climates. Swimmer’s ear is characterized by pain, tenderness, redness, and swelling of the external ear canal. Most cases can be treated easily with topical antimicrobials, according to a statement from the CDC.

Not surprisingly, the study showed that AOE cases peak during the summer months. A total of 44% of cases occurred during June, July, and August, noted Dr. Emily W. Piercefield of the CDC’s Division of Applied Sciences, and her colleagues.

The data showed that children aged 5-9 years accounted for the highest frequency of physician visits for AOE, at 18.6 visits/1,000 people. Children aged 10-14 years accounted for 15.8/1,000. Interestingly, adults age 20 years and older accounted for 53% of AOE-related physician visits.

Southerners had the highest frequency of visits, at 9.1/1,000. AOE cases were least frequent in the West, at 4.3/1,000. There was no difference in frequency between urban and rural residents.

The study authors obtained incidence estimates by using the CDC’s National Ambulatory Medical Care Survey for 2003-2007 and the 2007 Nationwide Emergency Department Sample. Costs were estimated through use of a commercial insurance database.

The estimated annual tally for direct health-care costs was $489 million. The average cost per case was $200 for those patients who did not require hospitalization. None of the ambulatory care patients required admission, but almost 3% of those who visited an emergency department for swimmer’s ear were hospitalized.

Health care providers spent an estimated 597,761 hours annually treating swimmer’s ear in the ambulatory-care setting, according to the study authors.

Among the prevention measures suggested by the CDC:

• Use ear plugs or bathing caps to reduce exposure of the ears to water.

• Dry the ears after swimming.

• Keep foreign objects – which could break the skin and create an avenue for infection – out of the ear.

The agency also cautioned against removing ear wax, which protects from infection. And it recommended that pool and water park operators maintain proper pH and chlorine levels to retard growth of Pseudomonas aeruginosa and Staphylococcus species, which are responsible for AOE infections.

The CDC has two websites for more information on swimmer’s ear and healthy swimming.

Swimmer’s ear caused an estimated 2.4 million trips to physician offices and emergency departments in 2007 and cost nearly $500 million to treat, the Centers for Disease Control and Prevention reported May 19.

The condition, also known as acute otitis externa (AOE), is easy to prevent, however – a fact the CDC is highlighting in advance of the nation’s swimming pools opening around Memorial Day weekend.

"Most people think of swimmer’s ear as a mild condition that quickly goes away, but this common infection is responsible for millions of illnesses and substantial medical costs each year," Dr. Michael Beach, associate director for healthy water at the CDC, said in a statement. "By taking simple steps before and after swimming or coming in contact with water, people can greatly reduce their risk of this painful infection," he said.

A study in the agency’s Morbidity and Mortality Weekly Report is the first to look at the national costs associated with swimmer’s ear, a common condition in which pathogens proliferate in a moist environment in the ear canal (MMWR 2011;60:605-9).

The condition occurs most often in people who are exposed frequently to water, through bathing or swimming, and also in residents of warm and humid climates. Swimmer’s ear is characterized by pain, tenderness, redness, and swelling of the external ear canal. Most cases can be treated easily with topical antimicrobials, according to a statement from the CDC.

Not surprisingly, the study showed that AOE cases peak during the summer months. A total of 44% of cases occurred during June, July, and August, noted Dr. Emily W. Piercefield of the CDC’s Division of Applied Sciences, and her colleagues.

The data showed that children aged 5-9 years accounted for the highest frequency of physician visits for AOE, at 18.6 visits/1,000 people. Children aged 10-14 years accounted for 15.8/1,000. Interestingly, adults age 20 years and older accounted for 53% of AOE-related physician visits.

Southerners had the highest frequency of visits, at 9.1/1,000. AOE cases were least frequent in the West, at 4.3/1,000. There was no difference in frequency between urban and rural residents.

The study authors obtained incidence estimates by using the CDC’s National Ambulatory Medical Care Survey for 2003-2007 and the 2007 Nationwide Emergency Department Sample. Costs were estimated through use of a commercial insurance database.

The estimated annual tally for direct health-care costs was $489 million. The average cost per case was $200 for those patients who did not require hospitalization. None of the ambulatory care patients required admission, but almost 3% of those who visited an emergency department for swimmer’s ear were hospitalized.

Health care providers spent an estimated 597,761 hours annually treating swimmer’s ear in the ambulatory-care setting, according to the study authors.

Among the prevention measures suggested by the CDC:

• Use ear plugs or bathing caps to reduce exposure of the ears to water.

• Dry the ears after swimming.

• Keep foreign objects – which could break the skin and create an avenue for infection – out of the ear.

The agency also cautioned against removing ear wax, which protects from infection. And it recommended that pool and water park operators maintain proper pH and chlorine levels to retard growth of Pseudomonas aeruginosa and Staphylococcus species, which are responsible for AOE infections.

The CDC has two websites for more information on swimmer’s ear and healthy swimming.

Swimmer’s ear caused an estimated 2.4 million trips to physician offices and emergency departments in 2007 and cost nearly $500 million to treat, the Centers for Disease Control and Prevention reported May 19.

The condition, also known as acute otitis externa (AOE), is easy to prevent, however – a fact the CDC is highlighting in advance of the nation’s swimming pools opening around Memorial Day weekend.

"Most people think of swimmer’s ear as a mild condition that quickly goes away, but this common infection is responsible for millions of illnesses and substantial medical costs each year," Dr. Michael Beach, associate director for healthy water at the CDC, said in a statement. "By taking simple steps before and after swimming or coming in contact with water, people can greatly reduce their risk of this painful infection," he said.

A study in the agency’s Morbidity and Mortality Weekly Report is the first to look at the national costs associated with swimmer’s ear, a common condition in which pathogens proliferate in a moist environment in the ear canal (MMWR 2011;60:605-9).

The condition occurs most often in people who are exposed frequently to water, through bathing or swimming, and also in residents of warm and humid climates. Swimmer’s ear is characterized by pain, tenderness, redness, and swelling of the external ear canal. Most cases can be treated easily with topical antimicrobials, according to a statement from the CDC.

Not surprisingly, the study showed that AOE cases peak during the summer months. A total of 44% of cases occurred during June, July, and August, noted Dr. Emily W. Piercefield of the CDC’s Division of Applied Sciences, and her colleagues.

The data showed that children aged 5-9 years accounted for the highest frequency of physician visits for AOE, at 18.6 visits/1,000 people. Children aged 10-14 years accounted for 15.8/1,000. Interestingly, adults age 20 years and older accounted for 53% of AOE-related physician visits.

Southerners had the highest frequency of visits, at 9.1/1,000. AOE cases were least frequent in the West, at 4.3/1,000. There was no difference in frequency between urban and rural residents.

The study authors obtained incidence estimates by using the CDC’s National Ambulatory Medical Care Survey for 2003-2007 and the 2007 Nationwide Emergency Department Sample. Costs were estimated through use of a commercial insurance database.

The estimated annual tally for direct health-care costs was $489 million. The average cost per case was $200 for those patients who did not require hospitalization. None of the ambulatory care patients required admission, but almost 3% of those who visited an emergency department for swimmer’s ear were hospitalized.

Health care providers spent an estimated 597,761 hours annually treating swimmer’s ear in the ambulatory-care setting, according to the study authors.

Among the prevention measures suggested by the CDC:

• Use ear plugs or bathing caps to reduce exposure of the ears to water.

• Dry the ears after swimming.

• Keep foreign objects – which could break the skin and create an avenue for infection – out of the ear.

The agency also cautioned against removing ear wax, which protects from infection. And it recommended that pool and water park operators maintain proper pH and chlorine levels to retard growth of Pseudomonas aeruginosa and Staphylococcus species, which are responsible for AOE infections.

The CDC has two websites for more information on swimmer’s ear and healthy swimming.

A federal program to help people with pre-existing conditions obtain health insurance has lagged in terms of the government’s projected enrollment, which may be partly because it has largely gone unnoticed as one of the benefits of the health reform law.

The Pre-Existing Condition Insurance Plan (PCIP) was launched in July 2010 with $5 billion in funding from the Affordable Care Act. The goal is to provide an insurance option to people who may be barred from coverage or who have to pay huge surcharges because of a pre-existing condition such as hypercholesterolemia or cancer. The program will be in force until 2014, when the new insurance exchanges go into effect and insurers are prohibited from denying coverage to adults with pre-existing conditions. (They are already barred from doing so for children.)

Although the Department of Health and Human Services initially estimated that several hundred thousand people might benefit from the PCIP, as of early May only about 18,000 people had enrolled, according to the government’s statistics.

In an interview, Richard Popper, director of insurance programs at the federal Center for Consumer Information and Insurance Oversight, would not comment on the number of enrollees. But he said that enrollment had been strongest in states with higher populations, such as Texas, California, Pennsylvania, and Illinois.

A "significant number" of patients with cancer, coronary artery disease, chronic obstructive pulmonary disease, and digestive system problems have accessed the program, said Mr. Popper, whose office is a division within the Centers for Medicare and Medicaid Services. The average person who has enrolled has annual medical costs of $20,000 a year, he said.

Enrollment, Eligibility How-Tos

To be eligible for the PCIP, an individual must have been without insurance for 6 months before enrollment. Mr. Popper said that because he was not working for DHHS at the time the Affordable Care Act was developed, he can’t comment on why this waiting period was made an essential part of the eligibility.

After that, the program varies according to whether it is administered by a state or the federal government, although there are minimum coverage criteria. Twenty-three states and the District of Columbia elected to have their PCIP program have a federally-run program, which is essentially the same as the plan offered by Blue Cross/Blue Shield to federal employees.

Twenty-seven states run their own programs.

Patients can apply at the PCIP website. They must prove that they have been denied insurance and have a pre-existing condition. That can be accomplished through a letter of denial from an insurer. In some states, an individual can qualify with a letter from a physician noting the pre-existing conditions and stating that the person has been diagnosed or treated for the conditions within the previous 6 months, said Mr. Popper.

In all cases, the patient gets coverage immediately. There is no waiting period, and premiums will be the same as for a healthy person in the same age range. There are no surcharges for health conditions.

At a meeting of the Association of Community Cancer Centers in March, Mr. Popper cited figures for the plan in Texas, which has a program that is operated by the federal government. For standard coverage, individuals could expect to pay from $174 to $557 monthly, depending on age, with a $2,000 deductible for medical care and a $500 deductible for medications. Higher benefit plans run $234-$749 for premiums, with $1,000 and $250 deductibles, respectively. There is also a health savings account option, with premiums of $181-$578 and a $2,500 deductible.

The out-of-pocket maximum that patients would pay under all plans is $5,950. There is no lifetime limit and no limit on physician visits or prescription drugs.

Relief in Rhode Island

At least one couple – Don and Renee Eddie of Rhode Island – has been thrilled to have stumbled upon the PCIP. The couple had been trying to stay insured over the last 6 years or so, through a patchwork of plans. They also have a son who is disabled.

Initially, they had family coverage through her teaching job, but after a series of back surgeries left her unable to work in 2004, she lost the coverage along with the job. Mr. Eddie had coverage through his workplace, Electric Boat, and when he retired in 2006, the Eddies elected a family plan through the company. But the premiums were $1,299 a month. "We did that for 18 months, and it was draining us," said Ms. Eddie in an interview.

They found a discount insurance program; the premiums were cheap at $300 a month, but the coverage was paltry. After being left with a $587 bill for a blood test, the family decided to drop the plan. And then, a few months later, in April 2010, trouble set in. One day, after doing some work at home, Mr. Eddie complained of chest pain. When he became sweaty, Ms. Eddie drove him down the road to a nearby fire department. They packed him up in an ambulance and took him to the emergency department.

Shortly thereafter he had two stents inserted and spent 4 days in intensive care. The bill came to $92,000.

Ms. Eddie went back to trying to find an affordable insurance plan for Mr. Eddie. They settled on one that would cost $700 a month, but at the last minute decided they couldn’t stand the financial burden and backed out. A few months later, she read about the PCIP in an article in the Providence Journal.

Ms. Eddie applied, and in October her husband got coverage for $519 a month through Blue Cross of Rhode Island. The state runs its own plan, which has a $1,000 deductible. Mr. Eddie’s premiums have risen this year, as he just turned 60, but they are still a relatively affordable $567, said Ms. Eddie.

His prescriptions, which include Plavix, simvastatin, and Crestor, are relatively affordable also, she said. The best part of the plan, according to Ms. Eddie, is the monthly call from a Blue Cross nurse coordinator to offer tips and to monitor his care. "It’s the first time we’ve had anything like that, so that’s a very nice component," said Ms. Eddie, who added that the "personal connection" made them feel as if they were getting better care.

"I’ve been very, very pleased with this program," said Ms. Eddie. She was able to resume coverage for herself through the retirement plan offered through her teaching position, and her son is receiving Medicaid benefits.

In the meantime, DHHS is trying to get the word out about the PCIP. Mr. Popper said that when people apply for disability under the Social Security program, they receive notification about the PCIP. Many insurance companies have also been advising patients who are rejected for coverage that the PCIP is a potential alternative, said Mr. Popper.

Finally, his office has been reaching out to hospitals and to physicians and provider organizations to educate them about the program, he said.

A federal program to help people with pre-existing conditions obtain health insurance has lagged in terms of the government’s projected enrollment, which may be partly because it has largely gone unnoticed as one of the benefits of the health reform law.

The Pre-Existing Condition Insurance Plan (PCIP) was launched in July 2010 with $5 billion in funding from the Affordable Care Act. The goal is to provide an insurance option to people who may be barred from coverage or who have to pay huge surcharges because of a pre-existing condition such as hypercholesterolemia or cancer. The program will be in force until 2014, when the new insurance exchanges go into effect and insurers are prohibited from denying coverage to adults with pre-existing conditions. (They are already barred from doing so for children.)

Although the Department of Health and Human Services initially estimated that several hundred thousand people might benefit from the PCIP, as of early May only about 18,000 people had enrolled, according to the government’s statistics.

In an interview, Richard Popper, director of insurance programs at the federal Center for Consumer Information and Insurance Oversight, would not comment on the number of enrollees. But he said that enrollment had been strongest in states with higher populations, such as Texas, California, Pennsylvania, and Illinois.

A "significant number" of patients with cancer, coronary artery disease, chronic obstructive pulmonary disease, and digestive system problems have accessed the program, said Mr. Popper, whose office is a division within the Centers for Medicare and Medicaid Services. The average person who has enrolled has annual medical costs of $20,000 a year, he said.

Enrollment, Eligibility How-Tos

To be eligible for the PCIP, an individual must have been without insurance for 6 months before enrollment. Mr. Popper said that because he was not working for DHHS at the time the Affordable Care Act was developed, he can’t comment on why this waiting period was made an essential part of the eligibility.

After that, the program varies according to whether it is administered by a state or the federal government, although there are minimum coverage criteria. Twenty-three states and the District of Columbia elected to have their PCIP program have a federally-run program, which is essentially the same as the plan offered by Blue Cross/Blue Shield to federal employees.

Twenty-seven states run their own programs.

Patients can apply at the PCIP website. They must prove that they have been denied insurance and have a pre-existing condition. That can be accomplished through a letter of denial from an insurer. In some states, an individual can qualify with a letter from a physician noting the pre-existing conditions and stating that the person has been diagnosed or treated for the conditions within the previous 6 months, said Mr. Popper.

In all cases, the patient gets coverage immediately. There is no waiting period, and premiums will be the same as for a healthy person in the same age range. There are no surcharges for health conditions.

At a meeting of the Association of Community Cancer Centers in March, Mr. Popper cited figures for the plan in Texas, which has a program that is operated by the federal government. For standard coverage, individuals could expect to pay from $174 to $557 monthly, depending on age, with a $2,000 deductible for medical care and a $500 deductible for medications. Higher benefit plans run $234-$749 for premiums, with $1,000 and $250 deductibles, respectively. There is also a health savings account option, with premiums of $181-$578 and a $2,500 deductible.

The out-of-pocket maximum that patients would pay under all plans is $5,950. There is no lifetime limit and no limit on physician visits or prescription drugs.

Relief in Rhode Island

At least one couple – Don and Renee Eddie of Rhode Island – has been thrilled to have stumbled upon the PCIP. The couple had been trying to stay insured over the last 6 years or so, through a patchwork of plans. They also have a son who is disabled.

Initially, they had family coverage through her teaching job, but after a series of back surgeries left her unable to work in 2004, she lost the coverage along with the job. Mr. Eddie had coverage through his workplace, Electric Boat, and when he retired in 2006, the Eddies elected a family plan through the company. But the premiums were $1,299 a month. "We did that for 18 months, and it was draining us," said Ms. Eddie in an interview.

They found a discount insurance program; the premiums were cheap at $300 a month, but the coverage was paltry. After being left with a $587 bill for a blood test, the family decided to drop the plan. And then, a few months later, in April 2010, trouble set in. One day, after doing some work at home, Mr. Eddie complained of chest pain. When he became sweaty, Ms. Eddie drove him down the road to a nearby fire department. They packed him up in an ambulance and took him to the emergency department.

Shortly thereafter he had two stents inserted and spent 4 days in intensive care. The bill came to $92,000.

Ms. Eddie went back to trying to find an affordable insurance plan for Mr. Eddie. They settled on one that would cost $700 a month, but at the last minute decided they couldn’t stand the financial burden and backed out. A few months later, she read about the PCIP in an article in the Providence Journal.

Ms. Eddie applied, and in October her husband got coverage for $519 a month through Blue Cross of Rhode Island. The state runs its own plan, which has a $1,000 deductible. Mr. Eddie’s premiums have risen this year, as he just turned 60, but they are still a relatively affordable $567, said Ms. Eddie.

His prescriptions, which include Plavix, simvastatin, and Crestor, are relatively affordable also, she said. The best part of the plan, according to Ms. Eddie, is the monthly call from a Blue Cross nurse coordinator to offer tips and to monitor his care. "It’s the first time we’ve had anything like that, so that’s a very nice component," said Ms. Eddie, who added that the "personal connection" made them feel as if they were getting better care.

"I’ve been very, very pleased with this program," said Ms. Eddie. She was able to resume coverage for herself through the retirement plan offered through her teaching position, and her son is receiving Medicaid benefits.

In the meantime, DHHS is trying to get the word out about the PCIP. Mr. Popper said that when people apply for disability under the Social Security program, they receive notification about the PCIP. Many insurance companies have also been advising patients who are rejected for coverage that the PCIP is a potential alternative, said Mr. Popper.

Finally, his office has been reaching out to hospitals and to physicians and provider organizations to educate them about the program, he said.

A federal program to help people with pre-existing conditions obtain health insurance has lagged in terms of the government’s projected enrollment, which may be partly because it has largely gone unnoticed as one of the benefits of the health reform law.

The Pre-Existing Condition Insurance Plan (PCIP) was launched in July 2010 with $5 billion in funding from the Affordable Care Act. The goal is to provide an insurance option to people who may be barred from coverage or who have to pay huge surcharges because of a pre-existing condition such as hypercholesterolemia or cancer. The program will be in force until 2014, when the new insurance exchanges go into effect and insurers are prohibited from denying coverage to adults with pre-existing conditions. (They are already barred from doing so for children.)

Although the Department of Health and Human Services initially estimated that several hundred thousand people might benefit from the PCIP, as of early May only about 18,000 people had enrolled, according to the government’s statistics.

In an interview, Richard Popper, director of insurance programs at the federal Center for Consumer Information and Insurance Oversight, would not comment on the number of enrollees. But he said that enrollment had been strongest in states with higher populations, such as Texas, California, Pennsylvania, and Illinois.

A "significant number" of patients with cancer, coronary artery disease, chronic obstructive pulmonary disease, and digestive system problems have accessed the program, said Mr. Popper, whose office is a division within the Centers for Medicare and Medicaid Services. The average person who has enrolled has annual medical costs of $20,000 a year, he said.

Enrollment, Eligibility How-Tos

To be eligible for the PCIP, an individual must have been without insurance for 6 months before enrollment. Mr. Popper said that because he was not working for DHHS at the time the Affordable Care Act was developed, he can’t comment on why this waiting period was made an essential part of the eligibility.

After that, the program varies according to whether it is administered by a state or the federal government, although there are minimum coverage criteria. Twenty-three states and the District of Columbia elected to have their PCIP program have a federally-run program, which is essentially the same as the plan offered by Blue Cross/Blue Shield to federal employees.

Twenty-seven states run their own programs.

Patients can apply at the PCIP website. They must prove that they have been denied insurance and have a pre-existing condition. That can be accomplished through a letter of denial from an insurer. In some states, an individual can qualify with a letter from a physician noting the pre-existing conditions and stating that the person has been diagnosed or treated for the conditions within the previous 6 months, said Mr. Popper.

In all cases, the patient gets coverage immediately. There is no waiting period, and premiums will be the same as for a healthy person in the same age range. There are no surcharges for health conditions.

At a meeting of the Association of Community Cancer Centers in March, Mr. Popper cited figures for the plan in Texas, which has a program that is operated by the federal government. For standard coverage, individuals could expect to pay from $174 to $557 monthly, depending on age, with a $2,000 deductible for medical care and a $500 deductible for medications. Higher benefit plans run $234-$749 for premiums, with $1,000 and $250 deductibles, respectively. There is also a health savings account option, with premiums of $181-$578 and a $2,500 deductible.

The out-of-pocket maximum that patients would pay under all plans is $5,950. There is no lifetime limit and no limit on physician visits or prescription drugs.

Relief in Rhode Island

At least one couple – Don and Renee Eddie of Rhode Island – has been thrilled to have stumbled upon the PCIP. The couple had been trying to stay insured over the last 6 years or so, through a patchwork of plans. They also have a son who is disabled.

Initially, they had family coverage through her teaching job, but after a series of back surgeries left her unable to work in 2004, she lost the coverage along with the job. Mr. Eddie had coverage through his workplace, Electric Boat, and when he retired in 2006, the Eddies elected a family plan through the company. But the premiums were $1,299 a month. "We did that for 18 months, and it was draining us," said Ms. Eddie in an interview.

They found a discount insurance program; the premiums were cheap at $300 a month, but the coverage was paltry. After being left with a $587 bill for a blood test, the family decided to drop the plan. And then, a few months later, in April 2010, trouble set in. One day, after doing some work at home, Mr. Eddie complained of chest pain. When he became sweaty, Ms. Eddie drove him down the road to a nearby fire department. They packed him up in an ambulance and took him to the emergency department.

Shortly thereafter he had two stents inserted and spent 4 days in intensive care. The bill came to $92,000.

Ms. Eddie went back to trying to find an affordable insurance plan for Mr. Eddie. They settled on one that would cost $700 a month, but at the last minute decided they couldn’t stand the financial burden and backed out. A few months later, she read about the PCIP in an article in the Providence Journal.

Ms. Eddie applied, and in October her husband got coverage for $519 a month through Blue Cross of Rhode Island. The state runs its own plan, which has a $1,000 deductible. Mr. Eddie’s premiums have risen this year, as he just turned 60, but they are still a relatively affordable $567, said Ms. Eddie.

His prescriptions, which include Plavix, simvastatin, and Crestor, are relatively affordable also, she said. The best part of the plan, according to Ms. Eddie, is the monthly call from a Blue Cross nurse coordinator to offer tips and to monitor his care. "It’s the first time we’ve had anything like that, so that’s a very nice component," said Ms. Eddie, who added that the "personal connection" made them feel as if they were getting better care.

"I’ve been very, very pleased with this program," said Ms. Eddie. She was able to resume coverage for herself through the retirement plan offered through her teaching position, and her son is receiving Medicaid benefits.

In the meantime, DHHS is trying to get the word out about the PCIP. Mr. Popper said that when people apply for disability under the Social Security program, they receive notification about the PCIP. Many insurance companies have also been advising patients who are rejected for coverage that the PCIP is a potential alternative, said Mr. Popper.

Finally, his office has been reaching out to hospitals and to physicians and provider organizations to educate them about the program, he said.

A federal program to help people with pre-existing conditions obtain health insurance has lagged in terms of the government’s projected enrollment, which may be partly because it has largely gone unnoticed as one of the benefits of the health reform law.

The Pre-Existing Condition Insurance Plan (PCIP) was launched in July 2010 with $5 billion in funding from the Affordable Care Act. The goal is to provide an insurance option to people who may be barred from coverage or who have to pay huge surcharges because of a pre-existing condition such as hypercholesterolemia or cancer. The program will be in force until 2014, when the new insurance exchanges go into effect and insurers are prohibited from denying coverage to adults with pre-existing conditions. (They are already barred from doing so for children.)

Although the Department of Health and Human Services initially estimated that several hundred thousand people might benefit from the PCIP, as of early May only about 18,000 people had enrolled, according to the government’s statistics.

In an interview, Richard Popper, director of insurance programs at the federal Center for Consumer Information and Insurance Oversight, would not comment on the number of enrollees. But he said that enrollment had been strongest in states with higher populations, such as Texas, California, Pennsylvania, and Illinois.

A "significant number" of patients with cancer, coronary artery disease, chronic obstructive pulmonary disease, and digestive system problems have accessed the program, said Mr. Popper, whose office is a division within the Centers for Medicare and Medicaid Services. The average person who has enrolled has annual medical costs of $20,000 a year, he said.

Enrollment, Eligibility How-Tos

To be eligible for the PCIP, an individual must have been without insurance for 6 months before enrollment. Mr. Popper said that because he was not working for DHHS at the time the Affordable Care Act was developed, he can’t comment on why this waiting period was made an essential part of the eligibility.

After that, the program varies according to whether it is administered by a state or the federal government, although there are minimum coverage criteria. Twenty-three states and the District of Columbia elected to have their PCIP program have a federally-run program, which is essentially the same as the plan offered by Blue Cross/Blue Shield to federal employees.

Twenty-seven states run their own programs.

Patients can apply at the PCIP website. They must prove that they have been denied insurance and have a pre-existing condition. That can be accomplished through a letter of denial from an insurer. In some states, an individual can qualify with a letter from a physician noting the pre-existing conditions and stating that the person has been diagnosed or treated for the conditions within the previous 6 months, said Mr. Popper.

In all cases, the patient gets coverage immediately. There is no waiting period, and premiums will be the same as for a healthy person in the same age range. There are no surcharges for health conditions.

At a meeting of the Association of Community Cancer Centers in March, Mr. Popper cited figures for the plan in Texas, which has a program that is operated by the federal government. For standard coverage, individuals could expect to pay from $174 to $557 monthly, depending on age, with a $2,000 deductible for medical care and a $500 deductible for medications. Higher benefit plans run $234-$749 for premiums, with $1,000 and $250 deductibles, respectively. There is also a health savings account option, with premiums of $181-$578 and a $2,500 deductible.

The out-of-pocket maximum that patients would pay under all plans is $5,950. There is no lifetime limit and no limit on physician visits or prescription drugs.

Relief in Rhode Island

At least one couple – Don and Renee Eddie of Rhode Island – has been thrilled to have stumbled upon the PCIP. The couple had been trying to stay insured over the last 6 years or so, through a patchwork of plans. They also have a son who is disabled.

Initially, they had family coverage through her teaching job, but after a series of back surgeries left her unable to work in 2004, she lost the coverage along with the job. Mr. Eddie had coverage through his workplace, Electric Boat, and when he retired in 2006, the Eddies elected a family plan through the company. But the premiums were $1,299 a month. "We did that for 18 months, and it was draining us," said Ms. Eddie in an interview.

They found a discount insurance program; the premiums were cheap at $300 a month, but the coverage was paltry. After being left with a $587 bill for a blood test, the family decided to drop the plan. And then, a few months later, in April 2010, trouble set in. One day, after doing some work at home, Mr. Eddie complained of chest pain. When he became sweaty, Ms. Eddie drove him down the road to a nearby fire department. They packed him up in an ambulance and took him to the emergency department.

Shortly thereafter he had two stents inserted and spent 4 days in intensive care. The bill came to $92,000.

Ms. Eddie went back to trying to find an affordable insurance plan for Mr. Eddie. They settled on one that would cost $700 a month, but at the last minute decided they couldn’t stand the financial burden and backed out. A few months later, she read about the PCIP in an article in the Providence Journal.

Ms. Eddie applied, and in October her husband got coverage for $519 a month through Blue Cross of Rhode Island. The state runs its own plan, which has a $1,000 deductible. Mr. Eddie’s premiums have risen this year, as he just turned 60, but they are still a relatively affordable $567, said Ms. Eddie.

His prescriptions, which include Plavix, simvastatin, and Crestor, are relatively affordable also, she said. The best part of the plan, according to Ms. Eddie, is the monthly call from a Blue Cross nurse coordinator to offer tips and to monitor his care. "It’s the first time we’ve had anything like that, so that’s a very nice component," said Ms. Eddie, who added that the "personal connection" made them feel as if they were getting better care.

"I’ve been very, very pleased with this program," said Ms. Eddie. She was able to resume coverage for herself through the retirement plan offered through her teaching position, and her son is receiving Medicaid benefits.

In the meantime, DHHS is trying to get the word out about the PCIP. Mr. Popper said that when people apply for disability under the Social Security program, they receive notification about the PCIP. Many insurance companies have also been advising patients who are rejected for coverage that the PCIP is a potential alternative, said Mr. Popper.

Finally, his office has been reaching out to hospitals and to physicians and provider organizations to educate them about the program, he said.

A federal program to help people with pre-existing conditions obtain health insurance has lagged in terms of the government’s projected enrollment, which may be partly because it has largely gone unnoticed as one of the benefits of the health reform law.

The Pre-Existing Condition Insurance Plan (PCIP) was launched in July 2010 with $5 billion in funding from the Affordable Care Act. The goal is to provide an insurance option to people who may be barred from coverage or who have to pay huge surcharges because of a pre-existing condition such as hypercholesterolemia or cancer. The program will be in force until 2014, when the new insurance exchanges go into effect and insurers are prohibited from denying coverage to adults with pre-existing conditions. (They are already barred from doing so for children.)

Although the Department of Health and Human Services initially estimated that several hundred thousand people might benefit from the PCIP, as of early May only about 18,000 people had enrolled, according to the government’s statistics.

In an interview, Richard Popper, director of insurance programs at the federal Center for Consumer Information and Insurance Oversight, would not comment on the number of enrollees. But he said that enrollment had been strongest in states with higher populations, such as Texas, California, Pennsylvania, and Illinois.

A "significant number" of patients with cancer, coronary artery disease, chronic obstructive pulmonary disease, and digestive system problems have accessed the program, said Mr. Popper, whose office is a division within the Centers for Medicare and Medicaid Services. The average person who has enrolled has annual medical costs of $20,000 a year, he said.

Enrollment, Eligibility How-Tos

To be eligible for the PCIP, an individual must have been without insurance for 6 months before enrollment. Mr. Popper said that because he was not working for DHHS at the time the Affordable Care Act was developed, he can’t comment on why this waiting period was made an essential part of the eligibility.

After that, the program varies according to whether it is administered by a state or the federal government, although there are minimum coverage criteria. Twenty-three states and the District of Columbia elected to have their PCIP program have a federally-run program, which is essentially the same as the plan offered by Blue Cross/Blue Shield to federal employees.

Twenty-seven states run their own programs.

Patients can apply at the PCIP website. They must prove that they have been denied insurance and have a pre-existing condition. That can be accomplished through a letter of denial from an insurer. In some states, an individual can qualify with a letter from a physician noting the pre-existing conditions and stating that the person has been diagnosed or treated for the conditions within the previous 6 months, said Mr. Popper.

In all cases, the patient gets coverage immediately. There is no waiting period, and premiums will be the same as for a healthy person in the same age range. There are no surcharges for health conditions.

At a meeting of the Association of Community Cancer Centers in March, Mr. Popper cited figures for the plan in Texas, which has a program that is operated by the federal government. For standard coverage, individuals could expect to pay from $174 to $557 monthly, depending on age, with a $2,000 deductible for medical care and a $500 deductible for medications. Higher benefit plans run $234-$749 for premiums, with $1,000 and $250 deductibles, respectively. There is also a health savings account option, with premiums of $181-$578 and a $2,500 deductible.

The out-of-pocket maximum that patients would pay under all plans is $5,950. There is no lifetime limit and no limit on physician visits or prescription drugs.

Relief in Rhode Island

At least one couple – Don and Renee Eddie of Rhode Island – has been thrilled to have stumbled upon the PCIP. The couple had been trying to stay insured over the last 6 years or so, through a patchwork of plans. They also have a son who is disabled.

Initially, they had family coverage through her teaching job, but after a series of back surgeries left her unable to work in 2004, she lost the coverage along with the job. Mr. Eddie had coverage through his workplace, Electric Boat, and when he retired in 2006, the Eddies elected a family plan through the company. But the premiums were $1,299 a month. "We did that for 18 months, and it was draining us," said Ms. Eddie in an interview.

They found a discount insurance program; the premiums were cheap at $300 a month, but the coverage was paltry. After being left with a $587 bill for a blood test, the family decided to drop the plan. And then, a few months later, in April 2010, trouble set in. One day, after doing some work at home, Mr. Eddie complained of chest pain. When he became sweaty, Ms. Eddie drove him down the road to a nearby fire department. They packed him up in an ambulance and took him to the emergency department.

Shortly thereafter he had two stents inserted and spent 4 days in intensive care. The bill came to $92,000.

Ms. Eddie went back to trying to find an affordable insurance plan for Mr. Eddie. They settled on one that would cost $700 a month, but at the last minute decided they couldn’t stand the financial burden and backed out. A few months later, she read about the PCIP in an article in the Providence Journal.

Ms. Eddie applied, and in October her husband got coverage for $519 a month through Blue Cross of Rhode Island. The state runs its own plan, which has a $1,000 deductible. Mr. Eddie’s premiums have risen this year, as he just turned 60, but they are still a relatively affordable $567, said Ms. Eddie.

His prescriptions, which include Plavix, simvastatin, and Crestor, are relatively affordable also, she said. The best part of the plan, according to Ms. Eddie, is the monthly call from a Blue Cross nurse coordinator to offer tips and to monitor his care. "It’s the first time we’ve had anything like that, so that’s a very nice component," said Ms. Eddie, who added that the "personal connection" made them feel as if they were getting better care.

"I’ve been very, very pleased with this program," said Ms. Eddie. She was able to resume coverage for herself through the retirement plan offered through her teaching position, and her son is receiving Medicaid benefits.

In the meantime, DHHS is trying to get the word out about the PCIP. Mr. Popper said that when people apply for disability under the Social Security program, they receive notification about the PCIP. Many insurance companies have also been advising patients who are rejected for coverage that the PCIP is a potential alternative, said Mr. Popper.

Finally, his office has been reaching out to hospitals and to physicians and provider organizations to educate them about the program, he said.

A federal program to help people with pre-existing conditions obtain health insurance has lagged in terms of the government’s projected enrollment, which may be partly because it has largely gone unnoticed as one of the benefits of the health reform law.

The Pre-Existing Condition Insurance Plan (PCIP) was launched in July 2010 with $5 billion in funding from the Affordable Care Act. The goal is to provide an insurance option to people who may be barred from coverage or who have to pay huge surcharges because of a pre-existing condition such as hypercholesterolemia or cancer. The program will be in force until 2014, when the new insurance exchanges go into effect and insurers are prohibited from denying coverage to adults with pre-existing conditions. (They are already barred from doing so for children.)

Although the Department of Health and Human Services initially estimated that several hundred thousand people might benefit from the PCIP, as of early May only about 18,000 people had enrolled, according to the government’s statistics.

In an interview, Richard Popper, director of insurance programs at the federal Center for Consumer Information and Insurance Oversight, would not comment on the number of enrollees. But he said that enrollment had been strongest in states with higher populations, such as Texas, California, Pennsylvania, and Illinois.

A "significant number" of patients with cancer, coronary artery disease, chronic obstructive pulmonary disease, and digestive system problems have accessed the program, said Mr. Popper, whose office is a division within the Centers for Medicare and Medicaid Services. The average person who has enrolled has annual medical costs of $20,000 a year, he said.

Enrollment, Eligibility How-Tos

To be eligible for the PCIP, an individual must have been without insurance for 6 months before enrollment. Mr. Popper said that because he was not working for DHHS at the time the Affordable Care Act was developed, he can’t comment on why this waiting period was made an essential part of the eligibility.

After that, the program varies according to whether it is administered by a state or the federal government, although there are minimum coverage criteria. Twenty-three states and the District of Columbia elected to have their PCIP program have a federally-run program, which is essentially the same as the plan offered by Blue Cross/Blue Shield to federal employees.

Twenty-seven states run their own programs.

Patients can apply at the PCIP website. They must prove that they have been denied insurance and have a pre-existing condition. That can be accomplished through a letter of denial from an insurer. In some states, an individual can qualify with a letter from a physician noting the pre-existing conditions and stating that the person has been diagnosed or treated for the conditions within the previous 6 months, said Mr. Popper.

In all cases, the patient gets coverage immediately. There is no waiting period, and premiums will be the same as for a healthy person in the same age range. There are no surcharges for health conditions.

At a meeting of the Association of Community Cancer Centers in March, Mr. Popper cited figures for the plan in Texas, which has a program that is operated by the federal government. For standard coverage, individuals could expect to pay from $174 to $557 monthly, depending on age, with a $2,000 deductible for medical care and a $500 deductible for medications. Higher benefit plans run $234-$749 for premiums, with $1,000 and $250 deductibles, respectively. There is also a health savings account option, with premiums of $181-$578 and a $2,500 deductible.

The out-of-pocket maximum that patients would pay under all plans is $5,950. There is no lifetime limit and no limit on physician visits or prescription drugs.

Relief in Rhode Island

At least one couple – Don and Renee Eddie of Rhode Island – has been thrilled to have stumbled upon the PCIP. The couple had been trying to stay insured over the last 6 years or so, through a patchwork of plans. They also have a son who is disabled.

Initially, they had family coverage through her teaching job, but after a series of back surgeries left her unable to work in 2004, she lost the coverage along with the job. Mr. Eddie had coverage through his workplace, Electric Boat, and when he retired in 2006, the Eddies elected a family plan through the company. But the premiums were $1,299 a month. "We did that for 18 months, and it was draining us," said Ms. Eddie in an interview.

They found a discount insurance program; the premiums were cheap at $300 a month, but the coverage was paltry. After being left with a $587 bill for a blood test, the family decided to drop the plan. And then, a few months later, in April 2010, trouble set in. One day, after doing some work at home, Mr. Eddie complained of chest pain. When he became sweaty, Ms. Eddie drove him down the road to a nearby fire department. They packed him up in an ambulance and took him to the emergency department.

Shortly thereafter he had two stents inserted and spent 4 days in intensive care. The bill came to $92,000.

Ms. Eddie went back to trying to find an affordable insurance plan for Mr. Eddie. They settled on one that would cost $700 a month, but at the last minute decided they couldn’t stand the financial burden and backed out. A few months later, she read about the PCIP in an article in the Providence Journal.

Ms. Eddie applied, and in October her husband got coverage for $519 a month through Blue Cross of Rhode Island. The state runs its own plan, which has a $1,000 deductible. Mr. Eddie’s premiums have risen this year, as he just turned 60, but they are still a relatively affordable $567, said Ms. Eddie.

His prescriptions, which include Plavix, simvastatin, and Crestor, are relatively affordable also, she said. The best part of the plan, according to Ms. Eddie, is the monthly call from a Blue Cross nurse coordinator to offer tips and to monitor his care. "It’s the first time we’ve had anything like that, so that’s a very nice component," said Ms. Eddie, who added that the "personal connection" made them feel as if they were getting better care.

"I’ve been very, very pleased with this program," said Ms. Eddie. She was able to resume coverage for herself through the retirement plan offered through her teaching position, and her son is receiving Medicaid benefits.

In the meantime, DHHS is trying to get the word out about the PCIP. Mr. Popper said that when people apply for disability under the Social Security program, they receive notification about the PCIP. Many insurance companies have also been advising patients who are rejected for coverage that the PCIP is a potential alternative, said Mr. Popper.

Finally, his office has been reaching out to hospitals and to physicians and provider organizations to educate them about the program, he said.

A federal program to help people with pre-existing conditions obtain health insurance has lagged in terms of the government’s projected enrollment, which may be partly because it has largely gone unnoticed as one of the benefits of the health reform law.

The Pre-Existing Condition Insurance Plan (PCIP) was launched in July 2010 with $5 billion in funding from the Affordable Care Act. The goal is to provide an insurance option to people who may be barred from coverage or who have to pay huge surcharges because of a pre-existing condition such as hypercholesterolemia or cancer. The program will be in force until 2014, when the new insurance exchanges go into effect and insurers are prohibited from denying coverage to adults with pre-existing conditions. (They are already barred from doing so for children.)

Although the Department of Health and Human Services initially estimated that several hundred thousand people might benefit from the PCIP, as of early May only about 18,000 people had enrolled, according to the government’s statistics.

In an interview, Richard Popper, director of insurance programs at the federal Center for Consumer Information and Insurance Oversight, would not comment on the number of enrollees. But he said that enrollment had been strongest in states with higher populations, such as Texas, California, Pennsylvania, and Illinois.

A "significant number" of patients with cancer, coronary artery disease, chronic obstructive pulmonary disease, and digestive system problems have accessed the program, said Mr. Popper, whose office is a division within the Centers for Medicare and Medicaid Services. The average person who has enrolled has annual medical costs of $20,000 a year, he said.

Enrollment, Eligibility How-Tos

To be eligible for the PCIP, an individual must have been without insurance for 6 months before enrollment. Mr. Popper said that because he was not working for DHHS at the time the Affordable Care Act was developed, he can’t comment on why this waiting period was made an essential part of the eligibility.

After that, the program varies according to whether it is administered by a state or the federal government, although there are minimum coverage criteria. Twenty-three states and the District of Columbia elected to have their PCIP program have a federally-run program, which is essentially the same as the plan offered by Blue Cross/Blue Shield to federal employees.

Twenty-seven states run their own programs.

Patients can apply at the PCIP website. They must prove that they have been denied insurance and have a pre-existing condition. That can be accomplished through a letter of denial from an insurer. In some states, an individual can qualify with a letter from a physician noting the pre-existing conditions and stating that the person has been diagnosed or treated for the conditions within the previous 6 months, said Mr. Popper.

In all cases, the patient gets coverage immediately. There is no waiting period, and premiums will be the same as for a healthy person in the same age range. There are no surcharges for health conditions.

At a meeting of the Association of Community Cancer Centers in March, Mr. Popper cited figures for the plan in Texas, which has a program that is operated by the federal government. For standard coverage, individuals could expect to pay from $174 to $557 monthly, depending on age, with a $2,000 deductible for medical care and a $500 deductible for medications. Higher benefit plans run $234-$749 for premiums, with $1,000 and $250 deductibles, respectively. There is also a health savings account option, with premiums of $181-$578 and a $2,500 deductible.

The out-of-pocket maximum that patients would pay under all plans is $5,950. There is no lifetime limit and no limit on physician visits or prescription drugs.

Relief in Rhode Island

At least one couple – Don and Renee Eddie of Rhode Island – has been thrilled to have stumbled upon the PCIP. The couple had been trying to stay insured over the last 6 years or so, through a patchwork of plans. They also have a son who is disabled.

Initially, they had family coverage through her teaching job, but after a series of back surgeries left her unable to work in 2004, she lost the coverage along with the job. Mr. Eddie had coverage through his workplace, Electric Boat, and when he retired in 2006, the Eddies elected a family plan through the company. But the premiums were $1,299 a month. "We did that for 18 months, and it was draining us," said Ms. Eddie in an interview.

They found a discount insurance program; the premiums were cheap at $300 a month, but the coverage was paltry. After being left with a $587 bill for a blood test, the family decided to drop the plan. And then, a few months later, in April 2010, trouble set in. One day, after doing some work at home, Mr. Eddie complained of chest pain. When he became sweaty, Ms. Eddie drove him down the road to a nearby fire department. They packed him up in an ambulance and took him to the emergency department.

Shortly thereafter he had two stents inserted and spent 4 days in intensive care. The bill came to $92,000.

Ms. Eddie went back to trying to find an affordable insurance plan for Mr. Eddie. They settled on one that would cost $700 a month, but at the last minute decided they couldn’t stand the financial burden and backed out. A few months later, she read about the PCIP in an article in the Providence Journal.

Ms. Eddie applied, and in October her husband got coverage for $519 a month through Blue Cross of Rhode Island. The state runs its own plan, which has a $1,000 deductible. Mr. Eddie’s premiums have risen this year, as he just turned 60, but they are still a relatively affordable $567, said Ms. Eddie.

His prescriptions, which include Plavix, simvastatin, and Crestor, are relatively affordable also, she said. The best part of the plan, according to Ms. Eddie, is the monthly call from a Blue Cross nurse coordinator to offer tips and to monitor his care. "It’s the first time we’ve had anything like that, so that’s a very nice component," said Ms. Eddie, who added that the "personal connection" made them feel as if they were getting better care.

"I’ve been very, very pleased with this program," said Ms. Eddie. She was able to resume coverage for herself through the retirement plan offered through her teaching position, and her son is receiving Medicaid benefits.

In the meantime, DHHS is trying to get the word out about the PCIP. Mr. Popper said that when people apply for disability under the Social Security program, they receive notification about the PCIP. Many insurance companies have also been advising patients who are rejected for coverage that the PCIP is a potential alternative, said Mr. Popper.

Finally, his office has been reaching out to hospitals and to physicians and provider organizations to educate them about the program, he said.

A federal program to help people with pre-existing conditions obtain health insurance has lagged in terms of the government’s projected enrollment, which may be partly because it has largely gone unnoticed as one of the benefits of the health reform law.

The Pre-Existing Condition Insurance Plan (PCIP) was launched in July 2010 with $5 billion in funding from the Affordable Care Act. The goal is to provide an insurance option to people who may be barred from coverage or who have to pay huge surcharges because of a pre-existing condition such as hypercholesterolemia or cancer. The program will be in force until 2014, when the new insurance exchanges go into effect and insurers are prohibited from denying coverage to adults with pre-existing conditions. (They are already barred from doing so for children.)

Although the Department of Health and Human Services initially estimated that several hundred thousand people might benefit from the PCIP, as of early May only about 18,000 people had enrolled, according to the government’s statistics.

In an interview, Richard Popper, director of insurance programs at the federal Center for Consumer Information and Insurance Oversight, would not comment on the number of enrollees. But he said that enrollment had been strongest in states with higher populations, such as Texas, California, Pennsylvania, and Illinois.

A "significant number" of patients with cancer, coronary artery disease, chronic obstructive pulmonary disease, and digestive system problems have accessed the program, said Mr. Popper, whose office is a division within the Centers for Medicare and Medicaid Services. The average person who has enrolled has annual medical costs of $20,000 a year, he said.

Enrollment, Eligibility How-Tos

To be eligible for the PCIP, an individual must have been without insurance for 6 months before enrollment. Mr. Popper said that because he was not working for DHHS at the time the Affordable Care Act was developed, he can’t comment on why this waiting period was made an essential part of the eligibility.

After that, the program varies according to whether it is administered by a state or the federal government, although there are minimum coverage criteria. Twenty-three states and the District of Columbia elected to have their PCIP program have a federally-run program, which is essentially the same as the plan offered by Blue Cross/Blue Shield to federal employees.

Twenty-seven states run their own programs.

Patients can apply at the PCIP website. They must prove that they have been denied insurance and have a pre-existing condition. That can be accomplished through a letter of denial from an insurer. In some states, an individual can qualify with a letter from a physician noting the pre-existing conditions and stating that the person has been diagnosed or treated for the conditions within the previous 6 months, said Mr. Popper.

In all cases, the patient gets coverage immediately. There is no waiting period, and premiums will be the same as for a healthy person in the same age range. There are no surcharges for health conditions.

At a meeting of the Association of Community Cancer Centers in March, Mr. Popper cited figures for the plan in Texas, which has a program that is operated by the federal government. For standard coverage, individuals could expect to pay from $174 to $557 monthly, depending on age, with a $2,000 deductible for medical care and a $500 deductible for medications. Higher benefit plans run $234-$749 for premiums, with $1,000 and $250 deductibles, respectively. There is also a health savings account option, with premiums of $181-$578 and a $2,500 deductible.

The out-of-pocket maximum that patients would pay under all plans is $5,950. There is no lifetime limit and no limit on physician visits or prescription drugs.

Relief in Rhode Island

At least one couple – Don and Renee Eddie of Rhode Island – has been thrilled to have stumbled upon the PCIP. The couple had been trying to stay insured over the last 6 years or so, through a patchwork of plans. They also have a son who is disabled.

Initially, they had family coverage through her teaching job, but after a series of back surgeries left her unable to work in 2004, she lost the coverage along with the job. Mr. Eddie had coverage through his workplace, Electric Boat, and when he retired in 2006, the Eddies elected a family plan through the company. But the premiums were $1,299 a month. "We did that for 18 months, and it was draining us," said Ms. Eddie in an interview.

They found a discount insurance program; the premiums were cheap at $300 a month, but the coverage was paltry. After being left with a $587 bill for a blood test, the family decided to drop the plan. And then, a few months later, in April 2010, trouble set in. One day, after doing some work at home, Mr. Eddie complained of chest pain. When he became sweaty, Ms. Eddie drove him down the road to a nearby fire department. They packed him up in an ambulance and took him to the emergency department.

Shortly thereafter he had two stents inserted and spent 4 days in intensive care. The bill came to $92,000.

Ms. Eddie went back to trying to find an affordable insurance plan for Mr. Eddie. They settled on one that would cost $700 a month, but at the last minute decided they couldn’t stand the financial burden and backed out. A few months later, she read about the PCIP in an article in the Providence Journal.

Ms. Eddie applied, and in October her husband got coverage for $519 a month through Blue Cross of Rhode Island. The state runs its own plan, which has a $1,000 deductible. Mr. Eddie’s premiums have risen this year, as he just turned 60, but they are still a relatively affordable $567, said Ms. Eddie.

His prescriptions, which include Plavix, simvastatin, and Crestor, are relatively affordable also, she said. The best part of the plan, according to Ms. Eddie, is the monthly call from a Blue Cross nurse coordinator to offer tips and to monitor his care. "It’s the first time we’ve had anything like that, so that’s a very nice component," said Ms. Eddie, who added that the "personal connection" made them feel as if they were getting better care.

"I’ve been very, very pleased with this program," said Ms. Eddie. She was able to resume coverage for herself through the retirement plan offered through her teaching position, and her son is receiving Medicaid benefits.

In the meantime, DHHS is trying to get the word out about the PCIP. Mr. Popper said that when people apply for disability under the Social Security program, they receive notification about the PCIP. Many insurance companies have also been advising patients who are rejected for coverage that the PCIP is a potential alternative, said Mr. Popper.

Finally, his office has been reaching out to hospitals and to physicians and provider organizations to educate them about the program, he said.

A federal program to help people with pre-existing conditions obtain health insurance has lagged in terms of the government’s projected enrollment, which may be partly because it has largely gone unnoticed as one of the benefits of the health reform law.

The Pre-Existing Condition Insurance Plan (PCIP) was launched in July 2010 with $5 billion in funding from the Affordable Care Act. The goal is to provide an insurance option to people who may be barred from coverage or who have to pay huge surcharges because of a pre-existing condition such as hypercholesterolemia or cancer. The program will be in force until 2014, when the new insurance exchanges go into effect and insurers are prohibited from denying coverage to adults with pre-existing conditions. (They are already barred from doing so for children.)

Although the Department of Health and Human Services initially estimated that several hundred thousand people might benefit from the PCIP, as of early May only about 18,000 people had enrolled, according to the government’s statistics.

In an interview, Richard Popper, director of insurance programs at the federal Center for Consumer Information and Insurance Oversight, would not comment on the number of enrollees. But he said that enrollment had been strongest in states with higher populations, such as Texas, California, Pennsylvania, and Illinois.

A "significant number" of patients with cancer, coronary artery disease, chronic obstructive pulmonary disease, and digestive system problems have accessed the program, said Mr. Popper, whose office is a division within the Centers for Medicare and Medicaid Services. The average person who has enrolled has annual medical costs of $20,000 a year, he said.

Enrollment, Eligibility How-Tos

To be eligible for the PCIP, an individual must have been without insurance for 6 months before enrollment. Mr. Popper said that because he was not working for DHHS at the time the Affordable Care Act was developed, he can’t comment on why this waiting period was made an essential part of the eligibility.

After that, the program varies according to whether it is administered by a state or the federal government, although there are minimum coverage criteria. Twenty-three states and the District of Columbia elected to have their PCIP program have a federally-run program, which is essentially the same as the plan offered by Blue Cross/Blue Shield to federal employees.

Twenty-seven states run their own programs.

Patients can apply at the PCIP website. They must prove that they have been denied insurance and have a pre-existing condition. That can be accomplished through a letter of denial from an insurer. In some states, an individual can qualify with a letter from a physician noting the pre-existing conditions and stating that the person has been diagnosed or treated for the conditions within the previous 6 months, said Mr. Popper.

In all cases, the patient gets coverage immediately. There is no waiting period, and premiums will be the same as for a healthy person in the same age range. There are no surcharges for health conditions.

At a meeting of the Association of Community Cancer Centers in March, Mr. Popper cited figures for the plan in Texas, which has a program that is operated by the federal government. For standard coverage, individuals could expect to pay from $174 to $557 monthly, depending on age, with a $2,000 deductible for medical care and a $500 deductible for medications. Higher benefit plans run $234-$749 for premiums, with $1,000 and $250 deductibles, respectively. There is also a health savings account option, with premiums of $181-$578 and a $2,500 deductible.

The out-of-pocket maximum that patients would pay under all plans is $5,950. There is no lifetime limit and no limit on physician visits or prescription drugs.

Relief in Rhode Island

At least one couple – Don and Renee Eddie of Rhode Island – has been thrilled to have stumbled upon the PCIP. The couple had been trying to stay insured over the last 6 years or so, through a patchwork of plans. They also have a son who is disabled.

Initially, they had family coverage through her teaching job, but after a series of back surgeries left her unable to work in 2004, she lost the coverage along with the job. Mr. Eddie had coverage through his workplace, Electric Boat, and when he retired in 2006, the Eddies elected a family plan through the company. But the premiums were $1,299 a month. "We did that for 18 months, and it was draining us," said Ms. Eddie in an interview.

They found a discount insurance program; the premiums were cheap at $300 a month, but the coverage was paltry. After being left with a $587 bill for a blood test, the family decided to drop the plan. And then, a few months later, in April 2010, trouble set in. One day, after doing some work at home, Mr. Eddie complained of chest pain. When he became sweaty, Ms. Eddie drove him down the road to a nearby fire department. They packed him up in an ambulance and took him to the emergency department.

Shortly thereafter he had two stents inserted and spent 4 days in intensive care. The bill came to $92,000.

Ms. Eddie went back to trying to find an affordable insurance plan for Mr. Eddie. They settled on one that would cost $700 a month, but at the last minute decided they couldn’t stand the financial burden and backed out. A few months later, she read about the PCIP in an article in the Providence Journal.

Ms. Eddie applied, and in October her husband got coverage for $519 a month through Blue Cross of Rhode Island. The state runs its own plan, which has a $1,000 deductible. Mr. Eddie’s premiums have risen this year, as he just turned 60, but they are still a relatively affordable $567, said Ms. Eddie.

His prescriptions, which include Plavix, simvastatin, and Crestor, are relatively affordable also, she said. The best part of the plan, according to Ms. Eddie, is the monthly call from a Blue Cross nurse coordinator to offer tips and to monitor his care. "It’s the first time we’ve had anything like that, so that’s a very nice component," said Ms. Eddie, who added that the "personal connection" made them feel as if they were getting better care.

"I’ve been very, very pleased with this program," said Ms. Eddie. She was able to resume coverage for herself through the retirement plan offered through her teaching position, and her son is receiving Medicaid benefits.

In the meantime, DHHS is trying to get the word out about the PCIP. Mr. Popper said that when people apply for disability under the Social Security program, they receive notification about the PCIP. Many insurance companies have also been advising patients who are rejected for coverage that the PCIP is a potential alternative, said Mr. Popper.

Finally, his office has been reaching out to hospitals and to physicians and provider organizations to educate them about the program, he said.

A federal program to help people with pre-existing conditions obtain health insurance has lagged in terms of the government’s projected enrollment, which may be partly because it has largely gone unnoticed as one of the benefits of the health reform law.

The Pre-Existing Condition Insurance Plan (PCIP) was launched in July 2010 with $5 billion in funding from the Affordable Care Act. The goal is to provide an insurance option to people who may be barred from coverage or who have to pay huge surcharges because of a pre-existing condition such as hypercholesterolemia or cancer. The program will be in force until 2014, when the new insurance exchanges go into effect and insurers are prohibited from denying coverage to adults with pre-existing conditions. (They are already barred from doing so for children.)

Although the Department of Health and Human Services initially estimated that several hundred thousand people might benefit from the PCIP, as of early May only about 18,000 people had enrolled, according to the government’s statistics.

In an interview, Richard Popper, director of insurance programs at the federal Center for Consumer Information and Insurance Oversight, would not comment on the number of enrollees. But he said that enrollment had been strongest in states with higher populations, such as Texas, California, Pennsylvania, and Illinois.

A "significant number" of patients with cancer, coronary artery disease, chronic obstructive pulmonary disease, and digestive system problems have accessed the program, said Mr. Popper, whose office is a division within the Centers for Medicare and Medicaid Services. The average person who has enrolled has annual medical costs of $20,000 a year, he said.

Enrollment, Eligibility How-Tos

To be eligible for the PCIP, an individual must have been without insurance for 6 months before enrollment. Mr. Popper said that because he was not working for DHHS at the time the Affordable Care Act was developed, he can’t comment on why this waiting period was made an essential part of the eligibility.

After that, the program varies according to whether it is administered by a state or the federal government, although there are minimum coverage criteria. Twenty-three states and the District of Columbia elected to have their PCIP program have a federally-run program, which is essentially the same as the plan offered by Blue Cross/Blue Shield to federal employees.

Twenty-seven states run their own programs.

Patients can apply at the PCIP website. They must prove that they have been denied insurance and have a pre-existing condition. That can be accomplished through a letter of denial from an insurer. In some states, an individual can qualify with a letter from a physician noting the pre-existing conditions and stating that the person has been diagnosed or treated for the conditions within the previous 6 months, said Mr. Popper.

In all cases, the patient gets coverage immediately. There is no waiting period, and premiums will be the same as for a healthy person in the same age range. There are no surcharges for health conditions.

At a meeting of the Association of Community Cancer Centers in March, Mr. Popper cited figures for the plan in Texas, which has a program that is operated by the federal government. For standard coverage, individuals could expect to pay from $174 to $557 monthly, depending on age, with a $2,000 deductible for medical care and a $500 deductible for medications. Higher benefit plans run $234-$749 for premiums, with $1,000 and $250 deductibles, respectively. There is also a health savings account option, with premiums of $181-$578 and a $2,500 deductible.

The out-of-pocket maximum that patients would pay under all plans is $5,950. There is no lifetime limit and no limit on physician visits or prescription drugs.

Relief in Rhode Island

At least one couple – Don and Renee Eddie of Rhode Island – has been thrilled to have stumbled upon the PCIP. The couple had been trying to stay insured over the last 6 years or so, through a patchwork of plans. They also have a son who is disabled.

Initially, they had family coverage through her teaching job, but after a series of back surgeries left her unable to work in 2004, she lost the coverage along with the job. Mr. Eddie had coverage through his workplace, Electric Boat, and when he retired in 2006, the Eddies elected a family plan through the company. But the premiums were $1,299 a month. "We did that for 18 months, and it was draining us," said Ms. Eddie in an interview.

They found a discount insurance program; the premiums were cheap at $300 a month, but the coverage was paltry. After being left with a $587 bill for a blood test, the family decided to drop the plan. And then, a few months later, in April 2010, trouble set in. One day, after doing some work at home, Mr. Eddie complained of chest pain. When he became sweaty, Ms. Eddie drove him down the road to a nearby fire department. They packed him up in an ambulance and took him to the emergency department.

Shortly thereafter he had two stents inserted and spent 4 days in intensive care. The bill came to $92,000.

Ms. Eddie went back to trying to find an affordable insurance plan for Mr. Eddie. They settled on one that would cost $700 a month, but at the last minute decided they couldn’t stand the financial burden and backed out. A few months later, she read about the PCIP in an article in the Providence Journal.

Ms. Eddie applied, and in October her husband got coverage for $519 a month through Blue Cross of Rhode Island. The state runs its own plan, which has a $1,000 deductible. Mr. Eddie’s premiums have risen this year, as he just turned 60, but they are still a relatively affordable $567, said Ms. Eddie.

His prescriptions, which include Plavix, simvastatin, and Crestor, are relatively affordable also, she said. The best part of the plan, according to Ms. Eddie, is the monthly call from a Blue Cross nurse coordinator to offer tips and to monitor his care. "It’s the first time we’ve had anything like that, so that’s a very nice component," said Ms. Eddie, who added that the "personal connection" made them feel as if they were getting better care.

"I’ve been very, very pleased with this program," said Ms. Eddie. She was able to resume coverage for herself through the retirement plan offered through her teaching position, and her son is receiving Medicaid benefits.

In the meantime, DHHS is trying to get the word out about the PCIP. Mr. Popper said that when people apply for disability under the Social Security program, they receive notification about the PCIP. Many insurance companies have also been advising patients who are rejected for coverage that the PCIP is a potential alternative, said Mr. Popper.

Finally, his office has been reaching out to hospitals and to physicians and provider organizations to educate them about the program, he said.

A federal program to help people with pre-existing conditions obtain health insurance has lagged in terms of the government’s projected enrollment, which may be partly because it has largely gone unnoticed as one of the benefits of the health reform law.

The Pre-Existing Condition Insurance Plan (PCIP) was launched in July 2010 with $5 billion in funding from the Affordable Care Act. The goal is to provide an insurance option to people who may be barred from coverage or who have to pay huge surcharges because of a pre-existing condition such as hypercholesterolemia or cancer. The program will be in force until 2014, when the new insurance exchanges go into effect and insurers are prohibited from denying coverage to adults with pre-existing conditions. (They are already barred from doing so for children.)

Although the Department of Health and Human Services initially estimated that several hundred thousand people might benefit from the PCIP, as of early May only about 18,000 people had enrolled, according to the government’s statistics.

In an interview, Richard Popper, director of insurance programs at the federal Center for Consumer Information and Insurance Oversight, would not comment on the number of enrollees. But he said that enrollment had been strongest in states with higher populations, such as Texas, California, Pennsylvania, and Illinois.

A "significant number" of patients with cancer, coronary artery disease, chronic obstructive pulmonary disease, and digestive system problems have accessed the program, said Mr. Popper, whose office is a division within the Centers for Medicare and Medicaid Services. The average person who has enrolled has annual medical costs of $20,000 a year, he said.

Enrollment, Eligibility How-Tos

To be eligible for the PCIP, an individual must have been without insurance for 6 months before enrollment. Mr. Popper said that because he was not working for DHHS at the time the Affordable Care Act was developed, he can’t comment on why this waiting period was made an essential part of the eligibility.

After that, the program varies according to whether it is administered by a state or the federal government, although there are minimum coverage criteria. Twenty-three states and the District of Columbia elected to have their PCIP program have a federally-run program, which is essentially the same as the plan offered by Blue Cross/Blue Shield to federal employees.

Twenty-seven states run their own programs.

Patients can apply at the PCIP website. They must prove that they have been denied insurance and have a pre-existing condition. That can be accomplished through a letter of denial from an insurer. In some states, an individual can qualify with a letter from a physician noting the pre-existing conditions and stating that the person has been diagnosed or treated for the conditions within the previous 6 months, said Mr. Popper.

In all cases, the patient gets coverage immediately. There is no waiting period, and premiums will be the same as for a healthy person in the same age range. There are no surcharges for health conditions.

At a meeting of the Association of Community Cancer Centers in March, Mr. Popper cited figures for the plan in Texas, which has a program that is operated by the federal government. For standard coverage, individuals could expect to pay from $174 to $557 monthly, depending on age, with a $2,000 deductible for medical care and a $500 deductible for medications. Higher benefit plans run $234-$749 for premiums, with $1,000 and $250 deductibles, respectively. There is also a health savings account option, with premiums of $181-$578 and a $2,500 deductible.

The out-of-pocket maximum that patients would pay under all plans is $5,950. There is no lifetime limit and no limit on physician visits or prescription drugs.

Relief in Rhode Island

At least one couple – Don and Renee Eddie of Rhode Island – has been thrilled to have stumbled upon the PCIP. The couple had been trying to stay insured over the last 6 years or so, through a patchwork of plans. They also have a son who is disabled.

Initially, they had family coverage through her teaching job, but after a series of back surgeries left her unable to work in 2004, she lost the coverage along with the job. Mr. Eddie had coverage through his workplace, Electric Boat, and when he retired in 2006, the Eddies elected a family plan through the company. But the premiums were $1,299 a month. "We did that for 18 months, and it was draining us," said Ms. Eddie in an interview.

They found a discount insurance program; the premiums were cheap at $300 a month, but the coverage was paltry. After being left with a $587 bill for a blood test, the family decided to drop the plan. And then, a few months later, in April 2010, trouble set in. One day, after doing some work at home, Mr. Eddie complained of chest pain. When he became sweaty, Ms. Eddie drove him down the road to a nearby fire department. They packed him up in an ambulance and took him to the emergency department.

Shortly thereafter he had two stents inserted and spent 4 days in intensive care. The bill came to $92,000.

Ms. Eddie went back to trying to find an affordable insurance plan for Mr. Eddie. They settled on one that would cost $700 a month, but at the last minute decided they couldn’t stand the financial burden and backed out. A few months later, she read about the PCIP in an article in the Providence Journal.

Ms. Eddie applied, and in October her husband got coverage for $519 a month through Blue Cross of Rhode Island. The state runs its own plan, which has a $1,000 deductible. Mr. Eddie’s premiums have risen this year, as he just turned 60, but they are still a relatively affordable $567, said Ms. Eddie.

His prescriptions, which include Plavix, simvastatin, and Crestor, are relatively affordable also, she said. The best part of the plan, according to Ms. Eddie, is the monthly call from a Blue Cross nurse coordinator to offer tips and to monitor his care. "It’s the first time we’ve had anything like that, so that’s a very nice component," said Ms. Eddie, who added that the "personal connection" made them feel as if they were getting better care.

"I’ve been very, very pleased with this program," said Ms. Eddie. She was able to resume coverage for herself through the retirement plan offered through her teaching position, and her son is receiving Medicaid benefits.

In the meantime, DHHS is trying to get the word out about the PCIP. Mr. Popper said that when people apply for disability under the Social Security program, they receive notification about the PCIP. Many insurance companies have also been advising patients who are rejected for coverage that the PCIP is a potential alternative, said Mr. Popper.

Finally, his office has been reaching out to hospitals and to physicians and provider organizations to educate them about the program, he said.

A federal program to help people with pre-existing conditions obtain health insurance has lagged in terms of the government’s projected enrollment, which may be partly because it has largely gone unnoticed as one of the benefits of the health reform law.

The Pre-Existing Condition Insurance Plan (PCIP) was launched in July 2010 with $5 billion in funding from the Affordable Care Act. The goal is to provide an insurance option to people who may be barred from coverage or who have to pay huge surcharges because of a pre-existing condition such as hypercholesterolemia or cancer. The program will be in force until 2014, when the new insurance exchanges go into effect and insurers are prohibited from denying coverage to adults with pre-existing conditions. (They are already barred from doing so for children.)

Although the Department of Health and Human Services initially estimated that several hundred thousand people might benefit from the PCIP, as of early May only about 18,000 people had enrolled, according to the government’s statistics.

In an interview, Richard Popper, director of insurance programs at the federal Center for Consumer Information and Insurance Oversight, would not comment on the number of enrollees. But he said that enrollment had been strongest in states with higher populations, such as Texas, California, Pennsylvania, and Illinois.

A "significant number" of patients with cancer, coronary artery disease, chronic obstructive pulmonary disease, and digestive system problems have accessed the program, said Mr. Popper, whose office is a division within the Centers for Medicare and Medicaid Services. The average person who has enrolled has annual medical costs of $20,000 a year, he said.

Enrollment, Eligibility How-Tos

To be eligible for the PCIP, an individual must have been without insurance for 6 months before enrollment. Mr. Popper said that because he was not working for DHHS at the time the Affordable Care Act was developed, he can’t comment on why this waiting period was made an essential part of the eligibility.

After that, the program varies according to whether it is administered by a state or the federal government, although there are minimum coverage criteria. Twenty-three states and the District of Columbia elected to have their PCIP program have a federally-run program, which is essentially the same as the plan offered by Blue Cross/Blue Shield to federal employees.

Twenty-seven states run their own programs.

Patients can apply at the PCIP website. They must prove that they have been denied insurance and have a pre-existing condition. That can be accomplished through a letter of denial from an insurer. In some states, an individual can qualify with a letter from a physician noting the pre-existing conditions and stating that the person has been diagnosed or treated for the conditions within the previous 6 months, said Mr. Popper.

In all cases, the patient gets coverage immediately. There is no waiting period, and premiums will be the same as for a healthy person in the same age range. There are no surcharges for health conditions.

At a meeting of the Association of Community Cancer Centers in March, Mr. Popper cited figures for the plan in Texas, which has a program that is operated by the federal government. For standard coverage, individuals could expect to pay from $174 to $557 monthly, depending on age, with a $2,000 deductible for medical care and a $500 deductible for medications. Higher benefit plans run $234-$749 for premiums, with $1,000 and $250 deductibles, respectively. There is also a health savings account option, with premiums of $181-$578 and a $2,500 deductible.

The out-of-pocket maximum that patients would pay under all plans is $5,950. There is no lifetime limit and no limit on physician visits or prescription drugs.

Relief in Rhode Island

At least one couple – Don and Renee Eddie of Rhode Island – has been thrilled to have stumbled upon the PCIP. The couple had been trying to stay insured over the last 6 years or so, through a patchwork of plans. They also have a son who is disabled.

Initially, they had family coverage through her teaching job, but after a series of back surgeries left her unable to work in 2004, she lost the coverage along with the job. Mr. Eddie had coverage through his workplace, Electric Boat, and when he retired in 2006, the Eddies elected a family plan through the company. But the premiums were $1,299 a month. "We did that for 18 months, and it was draining us," said Ms. Eddie in an interview.

They found a discount insurance program; the premiums were cheap at $300 a month, but the coverage was paltry. After being left with a $587 bill for a blood test, the family decided to drop the plan. And then, a few months later, in April 2010, trouble set in. One day, after doing some work at home, Mr. Eddie complained of chest pain. When he became sweaty, Ms. Eddie drove him down the road to a nearby fire department. They packed him up in an ambulance and took him to the emergency department.

Shortly thereafter he had two stents inserted and spent 4 days in intensive care. The bill came to $92,000.

Ms. Eddie went back to trying to find an affordable insurance plan for Mr. Eddie. They settled on one that would cost $700 a month, but at the last minute decided they couldn’t stand the financial burden and backed out. A few months later, she read about the PCIP in an article in the Providence Journal.

Ms. Eddie applied, and in October her husband got coverage for $519 a month through Blue Cross of Rhode Island. The state runs its own plan, which has a $1,000 deductible. Mr. Eddie’s premiums have risen this year, as he just turned 60, but they are still a relatively affordable $567, said Ms. Eddie.

His prescriptions, which include Plavix, simvastatin, and Crestor, are relatively affordable also, she said. The best part of the plan, according to Ms. Eddie, is the monthly call from a Blue Cross nurse coordinator to offer tips and to monitor his care. "It’s the first time we’ve had anything like that, so that’s a very nice component," said Ms. Eddie, who added that the "personal connection" made them feel as if they were getting better care.

"I’ve been very, very pleased with this program," said Ms. Eddie. She was able to resume coverage for herself through the retirement plan offered through her teaching position, and her son is receiving Medicaid benefits.

In the meantime, DHHS is trying to get the word out about the PCIP. Mr. Popper said that when people apply for disability under the Social Security program, they receive notification about the PCIP. Many insurance companies have also been advising patients who are rejected for coverage that the PCIP is a potential alternative, said Mr. Popper.

Finally, his office has been reaching out to hospitals and to physicians and provider organizations to educate them about the program, he said.

A federal program to help people with pre-existing conditions obtain health insurance has lagged in terms of the government’s projected enrollment, which may be partly because it has largely gone unnoticed as one of the benefits of the health reform law.

The Pre-Existing Condition Insurance Plan (PCIP) was launched in July 2010 with $5 billion in funding from the Affordable Care Act. The goal is to provide an insurance option to people who may be barred from coverage or who have to pay huge surcharges because of a pre-existing condition such as hypercholesterolemia or cancer. The program will be in force until 2014, when the new insurance exchanges go into effect and insurers are prohibited from denying coverage to adults with pre-existing conditions. (They are already barred from doing so for children.)

Although the Department of Health and Human Services initially estimated that several hundred thousand people might benefit from the PCIP, as of early May only about 18,000 people had enrolled, according to the government’s statistics.

In an interview, Richard Popper, director of insurance programs at the federal Center for Consumer Information and Insurance Oversight, would not comment on the number of enrollees. But he said that enrollment had been strongest in states with higher populations, such as Texas, California, Pennsylvania, and Illinois.

A "significant number" of patients with cancer, coronary artery disease, chronic obstructive pulmonary disease, and digestive system problems have accessed the program, said Mr. Popper, whose office is a division within the Centers for Medicare and Medicaid Services. The average person who has enrolled has annual medical costs of $20,000 a year, he said.

Enrollment, Eligibility How-Tos

To be eligible for the PCIP, an individual must have been without insurance for 6 months before enrollment. Mr. Popper said that because he was not working for DHHS at the time the Affordable Care Act was developed, he can’t comment on why this waiting period was made an essential part of the eligibility.

After that, the program varies according to whether it is administered by a state or the federal government, although there are minimum coverage criteria. Twenty-three states and the District of Columbia elected to have their PCIP program have a federally-run program, which is essentially the same as the plan offered by Blue Cross/Blue Shield to federal employees.

Twenty-seven states run their own programs.

Patients can apply at the PCIP website. They must prove that they have been denied insurance and have a pre-existing condition. That can be accomplished through a letter of denial from an insurer. In some states, an individual can qualify with a letter from a physician noting the pre-existing conditions and stating that the person has been diagnosed or treated for the conditions within the previous 6 months, said Mr. Popper.

In all cases, the patient gets coverage immediately. There is no waiting period, and premiums will be the same as for a healthy person in the same age range. There are no surcharges for health conditions.

At a meeting of the Association of Community Cancer Centers in March, Mr. Popper cited figures for the plan in Texas, which has a program that is operated by the federal government. For standard coverage, individuals could expect to pay from $174 to $557 monthly, depending on age, with a $2,000 deductible for medical care and a $500 deductible for medications. Higher benefit plans run $234-$749 for premiums, with $1,000 and $250 deductibles, respectively. There is also a health savings account option, with premiums of $181-$578 and a $2,500 deductible.

The out-of-pocket maximum that patients would pay under all plans is $5,950. There is no lifetime limit and no limit on physician visits or prescription drugs.

Relief in Rhode Island

At least one couple – Don and Renee Eddie of Rhode Island – has been thrilled to have stumbled upon the PCIP. The couple had been trying to stay insured over the last 6 years or so, through a patchwork of plans. They also have a son who is disabled.

Initially, they had family coverage through her teaching job, but after a series of back surgeries left her unable to work in 2004, she lost the coverage along with the job. Mr. Eddie had coverage through his workplace, Electric Boat, and when he retired in 2006, the Eddies elected a family plan through the company. But the premiums were $1,299 a month. "We did that for 18 months, and it was draining us," said Ms. Eddie in an interview.

They found a discount insurance program; the premiums were cheap at $300 a month, but the coverage was paltry. After being left with a $587 bill for a blood test, the family decided to drop the plan. And then, a few months later, in April 2010, trouble set in. One day, after doing some work at home, Mr. Eddie complained of chest pain. When he became sweaty, Ms. Eddie drove him down the road to a nearby fire department. They packed him up in an ambulance and took him to the emergency department.

Shortly thereafter he had two stents inserted and spent 4 days in intensive care. The bill came to $92,000.

Ms. Eddie went back to trying to find an affordable insurance plan for Mr. Eddie. They settled on one that would cost $700 a month, but at the last minute decided they couldn’t stand the financial burden and backed out. A few months later, she read about the PCIP in an article in the Providence Journal.

Ms. Eddie applied, and in October her husband got coverage for $519 a month through Blue Cross of Rhode Island. The state runs its own plan, which has a $1,000 deductible. Mr. Eddie’s premiums have risen this year, as he just turned 60, but they are still a relatively affordable $567, said Ms. Eddie.

His prescriptions, which include Plavix, simvastatin, and Crestor, are relatively affordable also, she said. The best part of the plan, according to Ms. Eddie, is the monthly call from a Blue Cross nurse coordinator to offer tips and to monitor his care. "It’s the first time we’ve had anything like that, so that’s a very nice component," said Ms. Eddie, who added that the "personal connection" made them feel as if they were getting better care.

"I’ve been very, very pleased with this program," said Ms. Eddie. She was able to resume coverage for herself through the retirement plan offered through her teaching position, and her son is receiving Medicaid benefits.

In the meantime, DHHS is trying to get the word out about the PCIP. Mr. Popper said that when people apply for disability under the Social Security program, they receive notification about the PCIP. Many insurance companies have also been advising patients who are rejected for coverage that the PCIP is a potential alternative, said Mr. Popper.

Finally, his office has been reaching out to hospitals and to physicians and provider organizations to educate them about the program, he said.

A federal program to help people with pre-existing conditions obtain health insurance has lagged in terms of the government’s projected enrollment, which may be partly because it has largely gone unnoticed as one of the benefits of the health reform law.

The Pre-Existing Condition Insurance Plan (PCIP) was launched in July 2010 with $5 billion in funding from the Affordable Care Act. The goal is to provide an insurance option to people who may be barred from coverage or who have to pay huge surcharges because of a pre-existing condition such as hypercholesterolemia or cancer. The program will be in force until 2014, when the new insurance exchanges go into effect and insurers are prohibited from denying coverage to adults with pre-existing conditions. (They are already barred from doing so for children.)

Although the Department of Health and Human Services initially estimated that several hundred thousand people might benefit from the PCIP, as of early May only about 18,000 people had enrolled, according to the government’s statistics.

In an interview, Richard Popper, director of insurance programs at the federal Center for Consumer Information and Insurance Oversight, would not comment on the number of enrollees. But he said that enrollment had been strongest in states with higher populations, such as Texas, California, Pennsylvania, and Illinois.

A "significant number" of patients with cancer, coronary artery disease, chronic obstructive pulmonary disease, and digestive system problems have accessed the program, said Mr. Popper, whose office is a division within the Centers for Medicare and Medicaid Services. The average person who has enrolled has annual medical costs of $20,000 a year, he said.

Enrollment, Eligibility How-Tos

To be eligible for the PCIP, an individual must have been without insurance for 6 months before enrollment. Mr. Popper said that because he was not working for DHHS at the time the Affordable Care Act was developed, he can’t comment on why this waiting period was made an essential part of the eligibility.

After that, the program varies according to whether it is administered by a state or the federal government, although there are minimum coverage criteria. Twenty-three states and the District of Columbia elected to have their PCIP program have a federally-run program, which is essentially the same as the plan offered by Blue Cross/Blue Shield to federal employees.

Twenty-seven states run their own programs.

Patients can apply at the PCIP website. They must prove that they have been denied insurance and have a pre-existing condition. That can be accomplished through a letter of denial from an insurer. In some states, an individual can qualify with a letter from a physician noting the pre-existing conditions and stating that the person has been diagnosed or treated for the conditions within the previous 6 months, said Mr. Popper.

In all cases, the patient gets coverage immediately. There is no waiting period, and premiums will be the same as for a healthy person in the same age range. There are no surcharges for health conditions.

At a meeting of the Association of Community Cancer Centers in March, Mr. Popper cited figures for the plan in Texas, which has a program that is operated by the federal government. For standard coverage, individuals could expect to pay from $174 to $557 monthly, depending on age, with a $2,000 deductible for medical care and a $500 deductible for medications. Higher benefit plans run $234-$749 for premiums, with $1,000 and $250 deductibles, respectively. There is also a health savings account option, with premiums of $181-$578 and a $2,500 deductible.

The out-of-pocket maximum that patients would pay under all plans is $5,950. There is no lifetime limit and no limit on physician visits or prescription drugs.

Relief in Rhode Island

At least one couple – Don and Renee Eddie of Rhode Island – has been thrilled to have stumbled upon the PCIP. The couple had been trying to stay insured over the last 6 years or so, through a patchwork of plans. They also have a son who is disabled.

Initially, they had family coverage through her teaching job, but after a series of back surgeries left her unable to work in 2004, she lost the coverage along with the job. Mr. Eddie had coverage through his workplace, Electric Boat, and when he retired in 2006, the Eddies elected a family plan through the company. But the premiums were $1,299 a month. "We did that for 18 months, and it was draining us," said Ms. Eddie in an interview.

They found a discount insurance program; the premiums were cheap at $300 a month, but the coverage was paltry. After being left with a $587 bill for a blood test, the family decided to drop the plan. And then, a few months later, in April 2010, trouble set in. One day, after doing some work at home, Mr. Eddie complained of chest pain. When he became sweaty, Ms. Eddie drove him down the road to a nearby fire department. They packed him up in an ambulance and took him to the emergency department.

Shortly thereafter he had two stents inserted and spent 4 days in intensive care. The bill came to $92,000.

Ms. Eddie went back to trying to find an affordable insurance plan for Mr. Eddie. They settled on one that would cost $700 a month, but at the last minute decided they couldn’t stand the financial burden and backed out. A few months later, she read about the PCIP in an article in the Providence Journal.

Ms. Eddie applied, and in October her husband got coverage for $519 a month through Blue Cross of Rhode Island. The state runs its own plan, which has a $1,000 deductible. Mr. Eddie’s premiums have risen this year, as he just turned 60, but they are still a relatively affordable $567, said Ms. Eddie.

His prescriptions, which include Plavix, simvastatin, and Crestor, are relatively affordable also, she said. The best part of the plan, according to Ms. Eddie, is the monthly call from a Blue Cross nurse coordinator to offer tips and to monitor his care. "It’s the first time we’ve had anything like that, so that’s a very nice component," said Ms. Eddie, who added that the "personal connection" made them feel as if they were getting better care.

"I’ve been very, very pleased with this program," said Ms. Eddie. She was able to resume coverage for herself through the retirement plan offered through her teaching position, and her son is receiving Medicaid benefits.

In the meantime, DHHS is trying to get the word out about the PCIP. Mr. Popper said that when people apply for disability under the Social Security program, they receive notification about the PCIP. Many insurance companies have also been advising patients who are rejected for coverage that the PCIP is a potential alternative, said Mr. Popper.

Finally, his office has been reaching out to hospitals and to physicians and provider organizations to educate them about the program, he said.

A federal program to help people with pre-existing conditions obtain health insurance has lagged in terms of the government’s projected enrollment, which may be partly because it has largely gone unnoticed as one of the benefits of the health reform law.

The Pre-Existing Condition Insurance Plan (PCIP) was launched in July 2010 with $5 billion in funding from the Affordable Care Act. The goal is to provide an insurance option to people who may be barred from coverage or who have to pay huge surcharges because of a pre-existing condition such as hypercholesterolemia or cancer. The program will be in force until 2014, when the new insurance exchanges go into effect and insurers are prohibited from denying coverage to adults with pre-existing conditions. (They are already barred from doing so for children.)

Although the Department of Health and Human Services initially estimated that several hundred thousand people might benefit from the PCIP, as of early May only about 18,000 people had enrolled, according to the government’s statistics.

In an interview, Richard Popper, director of insurance programs at the federal Center for Consumer Information and Insurance Oversight, would not comment on the number of enrollees. But he said that enrollment had been strongest in states with higher populations, such as Texas, California, Pennsylvania, and Illinois.

A "significant number" of patients with cancer, coronary artery disease, chronic obstructive pulmonary disease, and digestive system problems have accessed the program, said Mr. Popper, whose office is a division within the Centers for Medicare and Medicaid Services. The average person who has enrolled has annual medical costs of $20,000 a year, he said.

Enrollment, Eligibility How-Tos

To be eligible for the PCIP, an individual must have been without insurance for 6 months before enrollment. Mr. Popper said that because he was not working for DHHS at the time the Affordable Care Act was developed, he can’t comment on why this waiting period was made an essential part of the eligibility.

After that, the program varies according to whether it is administered by a state or the federal government, although there are minimum coverage criteria. Twenty-three states and the District of Columbia elected to have their PCIP program have a federally-run program, which is essentially the same as the plan offered by Blue Cross/Blue Shield to federal employees.

Twenty-seven states run their own programs.

Patients can apply at the PCIP website. They must prove that they have been denied insurance and have a pre-existing condition. That can be accomplished through a letter of denial from an insurer. In some states, an individual can qualify with a letter from a physician noting the pre-existing conditions and stating that the person has been diagnosed or treated for the conditions within the previous 6 months, said Mr. Popper.

In all cases, the patient gets coverage immediately. There is no waiting period, and premiums will be the same as for a healthy person in the same age range. There are no surcharges for health conditions.

At a meeting of the Association of Community Cancer Centers in March, Mr. Popper cited figures for the plan in Texas, which has a program that is operated by the federal government. For standard coverage, individuals could expect to pay from $174 to $557 monthly, depending on age, with a $2,000 deductible for medical care and a $500 deductible for medications. Higher benefit plans run $234-$749 for premiums, with $1,000 and $250 deductibles, respectively. There is also a health savings account option, with premiums of $181-$578 and a $2,500 deductible.

The out-of-pocket maximum that patients would pay under all plans is $5,950. There is no lifetime limit and no limit on physician visits or prescription drugs.

Relief in Rhode Island

At least one couple – Don and Renee Eddie of Rhode Island – has been thrilled to have stumbled upon the PCIP. The couple had been trying to stay insured over the last 6 years or so, through a patchwork of plans. They also have a son who is disabled.

Initially, they had family coverage through her teaching job, but after a series of back surgeries left her unable to work in 2004, she lost the coverage along with the job. Mr. Eddie had coverage through his workplace, Electric Boat, and when he retired in 2006, the Eddies elected a family plan through the company. But the premiums were $1,299 a month. "We did that for 18 months, and it was draining us," said Ms. Eddie in an interview.

They found a discount insurance program; the premiums were cheap at $300 a month, but the coverage was paltry. After being left with a $587 bill for a blood test, the family decided to drop the plan. And then, a few months later, in April 2010, trouble set in. One day, after doing some work at home, Mr. Eddie complained of chest pain. When he became sweaty, Ms. Eddie drove him down the road to a nearby fire department. They packed him up in an ambulance and took him to the emergency department.

Shortly thereafter he had two stents inserted and spent 4 days in intensive care. The bill came to $92,000.

Ms. Eddie went back to trying to find an affordable insurance plan for Mr. Eddie. They settled on one that would cost $700 a month, but at the last minute decided they couldn’t stand the financial burden and backed out. A few months later, she read about the PCIP in an article in the Providence Journal.

Ms. Eddie applied, and in October her husband got coverage for $519 a month through Blue Cross of Rhode Island. The state runs its own plan, which has a $1,000 deductible. Mr. Eddie’s premiums have risen this year, as he just turned 60, but they are still a relatively affordable $567, said Ms. Eddie.

His prescriptions, which include Plavix, simvastatin, and Crestor, are relatively affordable also, she said. The best part of the plan, according to Ms. Eddie, is the monthly call from a Blue Cross nurse coordinator to offer tips and to monitor his care. "It’s the first time we’ve had anything like that, so that’s a very nice component," said Ms. Eddie, who added that the "personal connection" made them feel as if they were getting better care.

"I’ve been very, very pleased with this program," said Ms. Eddie. She was able to resume coverage for herself through the retirement plan offered through her teaching position, and her son is receiving Medicaid benefits.

In the meantime, DHHS is trying to get the word out about the PCIP. Mr. Popper said that when people apply for disability under the Social Security program, they receive notification about the PCIP. Many insurance companies have also been advising patients who are rejected for coverage that the PCIP is a potential alternative, said Mr. Popper.

Finally, his office has been reaching out to hospitals and to physicians and provider organizations to educate them about the program, he said.