3 min read

How many people out there are like Martin Mead of Kennebunkport? Far too many, it seems. Mead was working as an emergency medical technician three years ago when he found himself with a cancer diagnosis and no health insurance. Though he looked into getting insurance, no company would take him without a year-long waiting period of paying for no coverage, and at exorbitant rates, at that.

With his only other option being to let the cancer win, Mead decided instead to go ahead with treatment to preserve his life ”“ and he racked up a mountain of debt doing it.

One year ago, however, he heard about the pre-existing Condition Insurance Plan offered through the Affordable Care Act that was passed by Congress last year. The plan is allowing him to have insurance at a lower rate than what is offered by private companies ”“ even at the maximum of $700 a month ”“ and for someone with fewer assets and income, it can be significantly less expensive, as low as $120 a month.

This safety net is important for people who have been denied coverage because of illnesses they had before seeking insurance or if they let their insurance lapse. What is one to do if they do not have a job that provides insurance coverage at an affordable group rate or if they simply cannot afford the coverage that is offered because their pay is too low?

Most would agree health care in this country is expensive, unfair and complicated. The Affordable Care Act took some steps to fix it, and while the bill as a whole is controversial, one simple fact remains: The bill is currently law, with health care exchanges planned to kick in 2014, and this PCIP program is here now for the taking.

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Anyone who is in Mead’s shoes will find that the PCIP program provides coverage for much less than the out-of-pocket expense for treatment of chronic illnesses or major ailments such cancer. The plan covers not only hospital care, but also medications, hospice care and preventive care, all at a price that is based on the person’s income, assets, and place of residence and other factors.

And although patients themselves have to pay the premiums, once 90 percent of the premium is collected, the federal government kicks in to cover the rest, meaning that everyone else’s insurance rates aren’t going to increase to cover the care of those with pre-existing conditions.

Unfortunately, in Maine, participation has been low in this program, and its supporters are betting that’s just because most people haven’t heard about it. Of the 130,000 without insurance in Maine, only 25 have signed up for this PCIP so far. That small number have yet to make much of a dent in Maine’s $17 million allotment through this program.

Many other parts of the new health care law were highly publicized, from the extended coverage for young people on their parents’ plans to the development of health care exchanges, but this PCIP option, which serves as a bridge until the exchanges take effect, had little publicity.

We hope the recent, concerted efforts of Consumers for Affordable Health Care and the regional Medicare offices to promote this program are successful and more people find that they can, in fact, have insurance they can afford.

Health care is a hallmark of an advanced society, and this PCIP option expands that care to those who need it most but have been previously unable to afford it. No one wants to see their neighbor suffering because they are afraid of the bill that will come after that doctor’s visit.

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Regardless of what people think about the new health care law, we would hope they see the value of this program and spread the word to neighbors and friends who have been “getting by” without the care they need, letting them know that a new option is available and directing them to visit mainecahc.org or call 1-800-965-7476 for more information.

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Questions? Comments? Contact Managing Editor Kristen Schulze Muszynski by calling 282-1535, Ext. 322, or via e-mail at kristenm@journaltribune.com.



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