There has been a lot of misinformation about how the public option is "really a sell out to insurance companies" posted on various websites. I am a chronically ill American. I know that the public option, and other provisions contained within the Senate HELP bill and the House tri-committee bill would make the lives of chronically ill Americans fairer. These bills would ban discrimination against the chronically ill (what the insurance industry terms purging) and the absurd practice of rescinding cancer patients insurance coverage due to previous bouts with acne. The House tri-committee bill ends the insurance industry’s ability to discriminate against the chronically ill with the following provision:
SEC. 112. GUARANTEED ISSUE AND RENEWAL FOR INSURED PLANS.
The requirements of sections 2711 (other than subsections (c) and (e)) and 2712 (other than paragraphs (3), and (6) of subsection (b) and subsection (e)) of the Public Health Service Act, relating to guaranteed availability and renewability of health insurance coverage, shall apply to individuals and employers in all individual and group health insurance coverage, whether offered to individuals or employers through the Health Insurance Exchange, through any employment-based health plan, or otherwise, in the same manner as such sections apply to employers and health insurance coverage offered in the small group market, except that such section 2712(b)(1) shall apply only if, before nonrenewal or discontinuation of coverage, the issuer has provided the enrollee with notice of non-payment of premiums and there is a grace period during which the enrollees has an opportunity to correct such nonpayment. Rescissions of such coverage shall be prohibited except in cases of fraud as defined in sections 2712(b)(2) of such Act.
This provision would end the absurd practice of for-profit insurers denying the chronically ill coverage in order to decrease their medical loss ratio, and therefore increase their stock price. This provision would go a long way towards giving the 11.4 million chronically ill Americans who lack health insurance access to the medical care they need.
When chronically ill Americans don’t have access to health insurance, they cut back on needed medical care. These type of actions–the type of actions which are encouraged by the current medical system inevitably lead to severe complications which can cost the government a million dollars and patients their lives.
Some argue that the reforms wouldn’t go far enough to eliminate the ability of insurers to charge the chronically ill more than healthy individuals. They argue that the House tri-committee bill and its sister the Senate HELP committee bill don’t go far enough to restrain the abuses of the insurance industry. The House tri-committee bill eliminates the insurance industry’s ability to charge the chronically ill higher premiums by adopting a community rating structure (the Senate HELP bill has a similar provision):
SEC. 113. INSURANCE RATING RULES.
(a) In General- The premium rate charged for an insured qualified health benefits plan may not vary except as follows:
1(1) LIMITED AGE VARIATION PERMITTED- By age (within such age categories as the Commissioner shall specify) so long as the ratio of the highest such premium to the lowest such premium does not exceed the ratio of 2 to 1.
(2) BY AREA- By premium rating area (as permitted by State insurance regulators or, in the case of Exchange-participating health benefits plans, as specified by the Commissioner in consultation with such regulators).
(3) BY FAMILY ENROLLMENT- By family enrollment (such as variations within categories and compositions of families) so long as the ratio of the premium for family enrollment (or enrollments) to the premium for individual enrollment is uniform, as specified under State law and consistent with rules of the Commissioner
Others argue that even these provisions don’t go far enough because insurers might still be able to rescind coverage of people with chronic illnesses. There would be little reason for insurers to ask about pre-existing conditions in a world where they are selling community rating products and are unable to deny coverage due to pre-existing conditions. Even so, the House bill eliminates insurers ability to rescind coverage except in cases of outright fraud (for instance, where an individual attempts to be reimbursed for procedures that never happened)
SEC. 162. ENDING HEALTH INSURANCE RESCISSION ABUSE.
(a) Clarification Regarding Application of Guaranteed Renewability of Individual Health Insurance Coverage- Section 2742 of the Public Health Service Act (42 U.S.C. 300gg-42) is amended–
(1) in its heading, by inserting ‘and continuation in force, including prohibition of rescission,’ after ‘guaranteed renewability’; and
(2) in subsection (a), by inserting ‘, including without rescission,’ after ‘continue in force’.
(b) Secretarial Guidance Regarding Rescissions- Section 2742 of such Act (42 U.S.C. 300gg-42) is amended by adding at the end the following:
‘(f) Rescission- A health insurance issuer may rescind health insurance coverage only upon clear and convincing evidence of fraud described in subsection (b)(2). The Secretary, no later than July 1, 2010, shall issue guidance implementing this requirement, including procedures for independent, external third party review.
In conclusion, the House tri-committee bill and its Senate Help bill sister ban the worst practices of the insurance industry, and provide affordable coverage for 97% of Americans. They do this for 1/7th the cost of the bailout given to Wall Street executives last fall.
Is the plan perfect? Absolutely not. But it would end discrimination against the chronically ill; it would expand access to proper medical care and drastically reduce the national tragedy known as medical bankruptcy; and it would take medical decisions out of the hands of insurance bureaucrats and put them back into the hands of doctors and patients.
The House tri-committee bill and its sister the Senate health care bill are more than worthy of our support. I hate to riff off of George W. Bush, but the reality is that you either stand with the 48 million uninsured Americans who would be helped by these bills, or you stand with those who, for whatever reason, want to keep 48 million people in the waiting room for decades.