Wednesday, June 17, 2009

Why I don't trust the US health insurance industry

The Los Angeles Times has a horrifying story about how several large insurers in California revoked policies based on the applicants' inadvertent omissions or honest mistakes. Insurance companies have the right to cancel policies, a process known as recission, in response to intentional fraud. Not doing so would drive premiums up for everyone. However, the insurers went a step further: they targeted certain diseases and rewarded employees for cancelling policies.

A Texas nurse said she lost her coverage, after she was diagnosed with aggressive breast cancer, for failing to disclose a visit to a dermatologist for acne.

The sister of an Illinois man who died of lymphoma said his policy was rescinded for the failure to report a possible aneurysm and gallstones that his physician noted in his chart but did not discuss with him.

The committee's investigation found that WellPoint's Blue Cross targeted individuals with more than 1,400 conditions, including breast cancer, lymphoma, pregnancy and high blood pressure. And the committee obtained documents that showed Blue Cross supervisors praised employees in performance reviews for rescinding policies.

One employee, for instance, received a perfect 5 for "exceptional performance" on an evaluation that noted the employee's role in dropping thousands of policyholders and avoiding nearly $10 million worth of medical care.

Committee members took turns, alternating Democrats and Republicans, condemning such practices.

Even worse, the executives refused to limit recission to cases of fraud - as they should be doing.

Late in the hearing, Stupak, the committee chairman, put the executives on the spot. Stupak asked each of them whether he would at least commit his company to immediately stop rescissions except where they could show "intentional fraud."

The answer from all three executives:


The only good thing is that this may undermine the insurers' efforts to shape the health reform debate.

Experts said it could undermine the industry's efforts to influence healthcare-overhaul plans working their way toward the White House.

"Talk about tone deaf," said Robert Laszewski, a former health insurance executive who now counsels companies as a consultant.

Democratic strategist Paul Begala said the hearing could hurt the industry's efforts to position itself in the debate.

"The industry has tried very hard in this current effort not to be the bad guy, not to wear the black hat," Begala said. "The trouble is all that hard work and goodwill is at risk if in fact they are pursuing" such practices.

This may make it easier to get a public option passed. Karen Ignagni, President and CEO of their trade association, has publicly said that she's aware the public has lost confidence in health insurers, and is willing to accept increased regulation of the industry. Insurers had better follow their own trade association.

No comments: