New insurance program will spin off contracting opportunities
by Mary Scott Nabers, CEO of Strategic Partnerships, Inc.
In March, Congress passed what is now called the Affordable Care Act. The new health insurance law has received much media attention and almost everyone has an opinion about it…but, there are many aspects of the initiative that have gone totally unnoticed by the general public. One example is that this new statute will create an abundance of work for public servants at both the state and federal levels. And, it will, without doubt, spin off lots of contracting opportunities to private sector vendors.
The law created what is called the Pre-Existing Condition Insurance Plan (PCIP). The plan makes health insurance available to individuals who have been denied coverage because of pre-existing conditions.
As is usually the case with something as large and as new as the Affordable Care Act, lots of start-up activity has been generated. State and federal agencies explain the law and then qualify participants as quickly as possible.
Coverage under the new law may be administered at the state level or by the U.S. Department of Health and Human Services. Each state may make a selection as to how the program is administered.
For many years, some states have operated insurance programs for “high-risk pools.” As complicated as it sounds, the law allows those states to build on what they are already doing, or allows the state to rely on the federal government to provide coverage. If a state decides to build on an existing program, the federal government will provide resources. But, either way, enrollment of eligible participants will be a huge task at the state level.
The mandate comes with $5 billion in funding and that is good because implementation will not come easily. Some have called the new law a government contracting firm’s full employment act because most states will have no option other than to outsource many of the efforts required to get the plan operational.
Initial estimates as to the number of qualified individuals are staggering. For instance, California may have as many as 847,000 individuals with pre-existing conditions. Texas is estimated to have at least 716,000. The Government Accounting Office believes that approximately 4 million people nationwide are eligible.
Enrollment in the program will have significant requirements which include, but are not limited to, the following:
- Citizens must be lawfully residing in the United States;
- Participants must have been uninsured for at least the last six months; and
- A pre-existing condition must have precluded coverage.
Just verifying those three requirements will be a monumental task. Contractors interested in outsourcing some of the work, providing augmented staff or offering technology solutions designed to speed the enrollment process should check with human service agencies in each state of interest.
Mary Scott Nabers is president and CEO of Strategic Partnerships, Inc., a 15-year-old procurement consulting and procurement research firm headquartered in Austin, Texas.
