Candace

Talmadge

Read Candace's bio and previous columns

June 12, 2009

Mandating Health Insurance Purchase is Not Reform

Let’s be clear about so-called health care reform shaping up in Congress with the spineless acquiescence of the Obama Administration.

It is a gift to the health insurance industry, pure and simple. Every American will be legally required to purchase health insurance or face stiff tax penalties.

Exactly how does such a punitive mandate improve actual health care in this country? It will do nothing, of course, except fatten health insurance companies’ profits. The rest of us are screwed because we don’t have hundreds of millions of dollars for Capitol Hill campaign contributions.

“Requiring Americans to buy insurance coverage from insurers who face no legal accountability will only lock them into the same problems plaguing consumers today,” Consumer Watchdog protested in a letter it recently sent to key members of Congress.

Amen to that. According to the California-based non-profit organization, health insurers routinely stick it those who pay for their products in a variety of ways. These include:

·         No legal accountability for mishandling patient claims. The Supreme Court pre-empted state laws in favor of the federal ERISA statute. Patient claims against HMOs or private carriers must be handled in federal courts, where they cannot sue for damages or penalties, only for recovery of the costs of services denied. This leaves the industry free to deny care without fear of consequences.

·         Staggering, cartel-like price increases in the 30 percent to 80 percent range per year that are driven primarily by insurers’ own overhead and profit considerations, not actual cost hikes in medical care.

·         Balance billing, in which the insured face extra bills from doctors or other providers for the portion of their services that insurance companies refuse to cover because they routinely low-ball “customary and reasonable” fees.

·         Fine-print contracts loaded with incomprehensible technical language so that consumers do not understand the limitations of the coverage they have purchased and pay for – until they need it and it’s not included.

·         Delaying care via “pre-authorization” or “coding” tactics to keep claims in administrative limbo. Often this results in care being no longer viable because a condition has progressed too far.

·         Refusing to clearly define terms like “medical necessity” and “experimental treatment” and then making false assertions about treatments physicians recommend in order not to pay for them.

·         Junk insurance that does not cap out-of-pocket costs (deductibles and co-pays) but does limit reimbursement amounts. As one example, Consumer Watchdog cited a policy that limited chemotherapy reimbursement to $1,000 per day when it usually costs $17,000 per day. The wife was left with $450,000 in unpaid medical bills after her husband died.

·         Limiting risk by refusing to insure people with pre-existing or chronic conditions such as allergies or diabetes. Although Senate and House reform plans supposedly bar this practice of refusing to insure pre-existing conditions, Consumer Watchdog says how extensively proposed reform legislation will still permit insurance companies to continue such underwriting tactics remains unclear.

·         Dumping the sick by cancelling coverage after a customer contracts a major, costly illness. Consumer Watchdog says nothing in the language of reform legislation prevents insurers from transferring seriously ill customers to skimpier insurance policies that do not cover their medical expenses.

Consumer Watchdog offers remedies for these abuses, of course. They include:

·         Setting up panels of independent medical experts to define whether any treatment, device or medication is “medically necessary” or “experimental” and to assess each disputed case, giving deference to the attending physician’s recommendation.

·         Restoring the rights of those denied treatment and harmed to sue in state courts for damages.

·         Capping out-of-pocket expenses so that patients do not risk bankruptcy over medical bills.

·         Banning balance billing so that no patient is held liable when an insurance company refuses to pay legitimate amounts for medical care.

·         Requiring state insurance regulators to do their jobs so that coverage is neither too expensive nor benefits inadequate.

Let us not hold our breath, though, waiting for the true health care reform light to dawn over Capitol Hill. That would endanger not just our health, but our very lives. 

© 2009 North Star Writers Group. May not be republished without permission.

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