Pretty much everyone agrees that rescission is a disgusting, immoral practice.
Rescission -- the technical term for canceling coverage on grounds that the company was misled -- is often considered among the most offensive practices in an insurance industry that already suffers from a distinct lack of popularity among the American public. Tales of cancellations have fueled outrage among regulators, analysts, doctors and, not least, plaintiffs' lawyers, who describe insurers as too eager to shed patients to widen profits.
The stories are legion, with the most-repeated being the one about the woman whose insurance was canceled when she was diagnosed with breast cancer. Because she had failed to disclose acne. But, as Steve Benen points out, with fictitious "death panels" getting more attention than this real, and lethal, practice, it's no wonder insurance executives have told Congress they have no intention of ending it. Or even restricting it to actual cases of fraud.
There's a new case of rescission in the news, and if you know what it's about, it lays bare (again) not just the evil of rescission but a number of other ways our current health care system is broken -- at least if your idea of a functioning system is that it promotes health without bankrupting individuals or the nation.
When 17-year-old Brianna Rice was diagnosed with celiac disease in February, she had health insurance.
She doesn't now.
In the months that followed her diagnosis, her insurance company, American Community Mutual Insurance, combed through her medical records and ruled that her parents lied on her application last year.
In May, American Community not only canceled her policy, but also rescinded coverage all the way back to the day it started -- Nov. 1.
That's classic and unremarkable in the annals of rescission, but consider the following. In the neighborhood of 1 in 133 people has celiac disease, whether they know it or not. That number is growing:A recent study compared tissue samples taken from young adults between 1948 and 1954, and recently-collected tissue samples from young adults and from people born in the same years as the earlier tissue samples. It’s 4.5 times more common in young adults now and 4 times more common in people born in the same years as the 1948-1954 samples. And the time between the onset of symptoms and diagnosis is frequently years. During that time, you're basically a walking pre-existing condition.
Even if insurance companies were sharply restricted and could no longer cancel someone's insurance for an unrelated condition, as acne to breast cancer -- even if they could only dump people's insurance if the person had failed to disclose something that turned out to be directly related to a later diagnosis -- this basically says that people with celiac disease are uninsurable. Why? Consider the possible symptoms:
- Diarrhea
- Vomiting
- Bloating
- Anemia
- Depression
- Miscarriage and infertility
- Osteoporosis
- Easy bruising
- Tooth discoloration and decay
- Nerve damage
- One hell of a rash
Basically, you walk around for a few years wondering why all this random stuff is going wrong with you, and then suddenly someone tells you it's all symptoms of the same thing, and it's incredibly cheap to treat and, all things considered, pretty easy (though it will not seem that way at first). Oh, and your insurance is canceled, and no, they won't be paying for the months of treatment and tests you've gone through to get to this point because you failed to disclose several cavities you've had over the years and some osteoporosis you didn't even know about.
If you switch insurance during the time between onset of symptoms and diagnosis, you're screwed not only because your insurance company can dump your ass based on any of a dozen symptoms you thought were meaningless, but because if you switch doctors, diagnosis is probably further delayed. With such disparate symptoms, consistency of care becomes central to diagnosis.
Take my case: From the time I was 16 until I was 26, I was sick all the time. Not dramatic illnesses with cool/scary names. Colds. And flus. And minor food poisonings. But when I say all the time, I mean that through college, my roommates not-so-jokingly referred to me as "sickly." One of them would come home with a cold involving two days of occasional nose-blowing. A day or two later, I would get slammed with a raw, sore throat, a swollen stuffed up running nose, headache, body-ache, chills. But I rarely went to the doctor and I wouldn't have told you I was sick.
Then I got food poisoning. I mean, hall of fame-style food poisoning. This may sound melodramatic, but it felt like I could die on the stairs of my own house. I passed out three times between my room and the front door, and only made it out to the campus public safety car waiting for me barefoot and leaving an unlocked door behind me. At the infirmary they couldn't get a vein for IV and could barely get a blood pressure reading, so they sent me to the emergency room. After some talk of pumping my stomach, I was admitted and -- in one of my life's defining pieces of luck -- I was seen by a gastroenterologist.
I saw her again two years later, when I got a stomach bug that was going around. This time I made it to the infirmary while I could still stand, but barely. It was another couple days on IV fluids and when I was taken to the gastroenterologist, she came into the office, looked at me, and said "you don't get this sick twice without an underlying condition."
If I had seen a different doctor, I would have been asked if I'd been this sick before and I'd have said yeah, I had food poisoning a couple years ago. But I wouldn't have wanted to seem like a drama queen, so I wouldn't have said I had thought I was going to die. I wouldn't have said that I was so dehydrated that when they raised the gurney my heart raced over 100 beats per minute from the strain of being propped half sitting. It would have looked like an isolated incident.
Because it didn't look like an isolated incident, because I saw the same doctor both times and she knew how sick I'd been, she started looking. And two blood draws later, I had a diagnosis that changed my life. Everyone should have that chance, but if you can't afford to go to the doctor, or even if you have insurance but it's changed several times or it doesn't provide for you to see the same doctor time to time, it will be delayed for you. I've heard stories of people's celiac going undiagnosed until they were losing teeth and hair, or through multiple miscarriages.
The irony of diagnosed celiac disease as a pre-existing condition is that once you know you have it, it is such a cheap condition to treat. You stop eating gluten -- which is to say, you stop eating wheat, barley, and rye. That's it. Just...stop. If you have good health care, you see a nutritionist a few times to learn the diet.
So when Brianna Rice's insurance company (in case you missed the name, it was the rat-bastards at American Community Mutual Insurance, which the state of Illinois has apparently investigated 12 times since 2007 for rescission) canceled her coverage, it was basically about the $20,000 in expenses leading to her diagnosis. They weren't even trying to get out of something like $5,000 per month for the foreseeable future to get her through chemotherapy. Not that that would be any more acceptable, but that's how short-sighted the profit motive is with these companies, and is allowed to be under our system. They dumped someone whose problems should be over as far as the insurance company is concerned. And in doing so, they basically declared open season on anyone with this autoimmune condition affecting nearly 1% of the population -- and growing. We didn't need another sign of how broken the system is, but we've got it.