WEST PALM BEACH, Fla. - As the United States Supreme Court prepares to weigh in on the constitutionality of the Patient Protection and Affordable Care Act, a growing number of people in South Florida and elsewhere have been caught in a widening bureaucracy and are being denied access to the health care they need.
A key part of the health care reform legislation, signed into law by President Barack Obama on March 23rd, 2010, required that insurers cover pre-existing conditions beginning in 2014.
In the interim, the government set up a Pre-Existing Condition Insurance Plan, or PCIP, as a bridge to provide coverage to people with pre-existing conditions.
"There's still a lot of uncertainty about who they're going to cover and who they're not going to cover and what qualifies as a policy and what doesn't," said Gary Boice, a retired Boynton Beach resident.
The government denied Boice's application for PCIP coverage three times because it said he had creditable coverage, something with a wide and varied definition.
Creditable coverage, according to the United States Department of Health and Human Services, includes group health and military insurance plans, COBRA and Medicaid. It also includes limited health insurance or "mini-medical plans" -- what Boice has.
PCIP doesn't cover someone whose had this kind of coverage within six months of applying for it.
" It's not an incentive for people to do the right thing. They're incentivizing people to go without insurance," said Benjamin Stille, a financial advisor and insurance specialist at BGS Financial Services.
"For me to advise people to not have insurance so they can get into this pool that will cover their pre-existing conditions but, in the interim, in that six-month period of time, they run the risk of, you know, just having life happen," he said.
According to the Government Accountability Office, enrollment in PCIP is significantly lower than first projected.
As of March 1st , 4,584 people in Florida had been enrolled ; 56,257 people had been enrolled nationwide.
Sixty-nine percent of the people denied coverage by the federally-run PCIP program had been denied for having creditable coverage within six months of applying for it.
"As long as it has a co-pay or a deductible they consider that insurance," said Shelley Nachum, a personal chef and Delray Beach resident. " They want me to go uninsured for six months before they would consider my application. It's crazy."
Sources at the Department of Health and Human services said the six-month creditable coverage requirement was a Congressional mandate.
The PCIP program, sources said, was designed to immediately help consumers who were uninsured and had a pre-existing condition.
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