NHeLP comments to HHS on interim final rules for the Pre-Existing Condition Insurance Plan Program

Executive Summary

NHeLP comments to the U.S. Department of Health and Human Services on interim final rules for the Pre-Existing Condition Insurance Plan Program (PCIP) under the Patient Protection and Affordable Care Act

The Honorable Kathleen Sebelius
U.S. Department of Health and Human Services
Hubert H. Humphrey Building
200 Independence Avenue, SW
Washington, D.C. 20201
RE: Comments on OCIIO-9995-IFC, Interim Final Rule Regarding the Pre-Existing Condition Insurance Plan Program
Dear Madam Secretary:
The National Health Law Program (NHeLP) is a national public interest law firm that seeks to improve health care for America’s working and unemployed poor, people of color, the elderly, women, children, and people with disabilities. We are pleased to submit these comments on the Interim Final Rules for the Pre-Existing Condition Insurance Plan Program (PCIP) under the Patient Protection and Affordable Care Act (PPACA). NHeLP supports these regulations administering the PCIP because it provides health care coverage to those with pre-existing conditions, many of whom were unable to obtain coverage.
In the discussion below, we offer comments to help strengthen the rules. The comments are delivered in the order of the interim final rules.
NHeLP?s interest in these regulations derives in large part from our focus on improving access and quality of care for low/limited-income and underserved populations. In particular, we have significant experience in the areas of language access and women?s/reproductive health, and we have focused much of our comments on those areas.
§ 152.15: Enrollment and Disenrollment Process
Section 152.15 provides the process by which individuals can be enrolled and disenrolled in the PCIP program. In recognition that our nation has a diverse population, with many that speak a language other than English, we strongly urge OCIIO to ensure that the enrollment and disenrollment process be completed in a culturally and linguistically appropriate manner.
Language access is one aspect of cultural competence that is essential to quality care for individuals with limited English proficiency (LEP). According to the American Community Survey, over 55 million people speak a language other than English at home. Nearly 5% of all households are deemed ?linguistically isolated,? meaning that every member of the household over age 14 speaks English less than very well. Over 25 million (9% of the population) speak English less than ?very well,? and for health care purposes may be considered to be LEP.
Health care providers from across the country have reported language difficulties and inadequate funding of language services to be major barriers to LEP individuals? access to health care, and a serious threat to the quality of the care they receive.1 Research documents how the lack of language services creates a barrier to and diminishes the quality of health care for limited English proficient individuals.2 Language barriers impact access to care: non-English speaking patients are less likely to use primary and preventive care and public health services, are more likely to use emergency rooms, and once at the emergency room, they receive far fewer services than their English speaking counterparts.3

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