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Life Health > Health Insurance

Pre-existing Conditions

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What is it about this business?

A few weeks ago, I wrote a piece called ‘Tone Deaf,’ which spoke to the health insurance industry’s propensity for shooting itself in the foot, with ever more powerful weapons as time goes on.

That was before the health care reform bill was enacted into law.

But no sooner had the bill been signed by President Obama than health insurers were looking for loopholes to avoid complying with some provisions. 

So, of course, the one that gained the most notoriety had to do with insurers parsing the bill’s fine print and coming up with a justification for not insuring some kids with pre-existing conditions until 2014. 

Despite what the fine print may say and however finely one may parse it, it is obvious what the law’s spirit is for insuring children with pre-existing conditions—that is to say, this is to start in September.  It’s obviously what the bill’s writers meant and what the President had been trumpeting as a major immediate benefit of the bill.

Why, then, of all possible provisions in a 2,000+-page law do health insurers pick this one upon which to make their first play?  Is this business so hopelessly addicted to being considered the bad guy that it has become a self-fulfilling prophecy?   Or is it the thrill of seeing how far it can go?  Or does it get off on the anger such moves engender?

The responses can get pretty angry.

Here’s what Sen. John D. Rockefeller IV, D-W.Va., had to say: “The ink has not yet dried on the health care reform bill, and already some deplorable health insurance companies are trying to duck away from covering children with pre-existing conditions. This is outrageous.”

Another statement had him using the word ‘reprehensible.’

Kathleen Sebelius, Health and Human Services Secretary, wrote to Karen Ignagni, president of America’s Health Insurance Plans, that health insurers should stop looking for “non-existent loopholes.”  Sebelius also said she would be she would be issuing regulations in coming weeks that would clarify that “the term ‘pre-existing condition exclusion’ applies to both a child’s access to plan and to his or her benefits once he or she is in the plan.”

To cause such a needless stir, we must be talking about millions of kids, right?  Well, not exactly. 

According to the Wall Street Journal (and since it appeared in the Journal even the industry’s staunchest defenders will accept it as gospel), the figure is 1% to 2% of the estimated 8 million uninsured children—that is, 80,000 to 160,000 kids.

In referring to these numbers, the Journal quoted Sara Rosenbaum, chairwoman of the health policy department at George Washington University, as saying: “We’re talking nationwide about a handful of children…I can’t imagine why insurance companies are fighting this so hard.”

As the pressure grew, insurers saw the light.  An AHIP spokesman said, “We understand policymakers are contemplating changes to the provisions related to coverage for children, and we will implement any revisions that are made.”

Couldn’t somebody have thought of this before the lawyers got their fangs into the bill?  And if not, why not? 

Hey, Dr. Phil, do you ever take entire industries as subjects on your show?  The health insurance business needs help and while it’s true the business is not a kid, it sure has a pre-existing condition.


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