Wednesday, Jan. 31, 2007 | 7:02 a.m.
P resident Bush's health care reform proposal revolves around incentives for people to purchase their own coverage on the open market.
But as we noted in an editorial on Sunday, it isn't easy for individuals to obtain health coverage directly from insurance companies. While people enrolled in employer-provided group plans cannot be refused coverage, insurers often look for excuses to reject those seeking coverage privately as individuals or families.
A story by USA Today on Monday shows that even those who manage to obtain coverage on their own can be left holding the tab for thousands in unpaid medical expenses when insurance companies retroactively cancel policies.
These aren't small, unknown companies but big insurers, such as Blue Cross of California and Nationwide, USA Today reports. Spokesmen for these companies said revocations are rare and happen only because policyholders failed to provide complete medical histories.
People should not lie on their insurance applications. But, as USA Today shows, information that insurers consider as undisclosed can include years-old diagnostic tests for which the results were normal. Insurers also have canceled policies after learning clients failed to report doctors' visits for conditions that have nothing to do with the procedures for which payment is being sought. And other health care consumers have told of losing their coverage after insurers said patients should have known or suspected that they had a disease, even without a doctor's diagnosis.
These practices are, for the most part, legal. States typically allow companies to set their own application standards for choosing who they will, or won't, cover. But some states are trying to change that. Connecticut's attorney general, for example, wants to require insurers to prove that clients intentionally lied on their applications before coverage can be revoked. California Gov. Arnold Schwarzenegger's sweeping health care reform package would prohibit health insurers from refusing to cover people.
However, Bush's health care reform measure places no onus on insurers to accept clients, even though it centers on individuals purchasing their own coverage. Health care reforms that fail to include minimum coverage requirements for health insurers cannot adequately address the nation's health care crisis.
All members of the health delivery system - including insurers - must be held accountable and help to ensure that Americans have reasonable access to coverage and care.
archive
