We've all heard all the tales...people dropped from insurer rolls because they failed to disclose their prescription-netting acne from two decades ago; how WellPoint spent years targeting women with breast cancer for policy cancellation, etc. I mean, if you're going to get sick, have the decency to do so with something inexpensive to treat, won't you?
But we all already know how rapacious and amoral most health insurers are; that's not the point here. The point is what to do about it and Sebelius, HHS et al are on it. She's already waged a successful campaign to get insurers to extend coverage to 26-year olds voluntarily ahead of the September deadline. And now, she's taking the same tack with rescission.
The portion of the law that ends this odious practice doesn't go into effect until September, but in the wake of the breast cancer imbroglio, Sebelius is once again (and hopefully none-too-subtly) urging pro-active cooperation in adapting to the letter (and spirit) of the new law. And if this is what she's saying and doing in the public eye, I can only imagine what kinds of discussions she and her teams are having behind closed doors:
April 22, 2010
[To: Angela Braly, WellPoint]
Dear Ms. Braly:
I was surprised and disappointed to read media accounts indicating that WellPoint routinely rescinds health insurance coverage from women recently diagnosed with breast cancer. Today’s report from Reuters indicating that your company “has specifically targeted women with breast cancer for aggressive investigation with the intent to cancel their policies” is disturbing, and this practice is deplorable.
As you know, the practice described in this article will soon be illegal. The Affordable Care Act specifically prohibits insurance companies from rescinding policies, except in cases of fraud or intentional misrepresentation of material fact.
WellPoint should not wait to end the unconscionable practice of deliberately working to deny health insurance coverage to women diagnosed with breast cancer. I urge you to immediately cease these practices and abandon your efforts to rescind health insurance coverage from patients who need it most.
Breast cancer is the second-leading type of cancer among women, has touched millions of families, and will affect one in eight American women during their lifetime. This year alone, an estimated 192,000 American women will be diagnosed with breast cancer.
I hope you will consider these women and their families as you work to end this harmful practice.
Sincerely,
Kathleen Sebelius
Still a tad subtle for my tastes, but I'll take "unconscionable" and "deplorable" for now, until the practice is finally made illegal this fall. What exactly happens this fall? Here are sections 2702 and 2703, the relevant portions of PPACA:
‘SEC. 2702. GUARANTEED AVAILABILITY OF COVERAGE.
‘‘(a) GUARANTEED ISSUANCE OF COVERAGE IN THE INDIVIDUAL AND GROUP MARKET.
Subject to subsections (b) through (e), each health insurance issuer that offers health insurance coverage in the individual or group market in a State must accept every employer and individual in the State that applies for such coverage.
‘‘(b) ENROLLMENT.—
‘‘(1) RESTRICTION.—A health insurance issuer described in subsection (a) may restrict enrollment in coverage described in such subsection to open or special enrollment periods.
‘‘(2) ESTABLISHMENT.—A health insurance issuer described in subsection (a) shall, in accordance with the regulations promulgated under paragraph (3), establish special enrollment periods for qualifying events (under section 603 of the Employee Retirement Income Security Act of 1974).
‘‘(3) REGULATIONS.—The Secretary shall promulgate regulations with respect to enrollment periods under paragraphs (1) and (2).
I can't believe I'm excited about rules, for crying out loud. I've hated them my entire life, but I positively cannot wait until June when Sebelius lays it down. Because it's all about the rules of enforcement. Thankfully, Sebelius seems to be quite the fighter and she definitely knows what kind of loopholes to watch for and avoid. She's on these jackals like white on rice. And so is the law; Sections 2703 and 2705 take 2702 even further:
‘‘SEC. 2703. GUARANTEED RENEWABILITY OF COVERAGE.
‘‘(a) IN GENERAL.—Except as provided in this section, if a health insurance issuer offers health insurance coverage in the individual or group market, the issuer must renew or continue in force such coverage at the option of the plan sponsor or the individual, as applicable.
‘‘SEC. 2705. PROHIBITING DISCRIMINATION AGAINST INDIVIDUAL PARTICIPANTS AND BENEFICIARIES BASED ON HEALTH STATUS.
‘‘(a) IN GENERAL.—A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan or coverage based on any of the following health status-related factors in relation to the individual or a dependent of the individual:
‘‘(1) Health status.
‘‘(2) Medical condition (including both physical and mental illnesses).
‘‘(3) Claims experience.
‘‘(4) Receipt of health care.
‘‘(5) Medical history.
‘‘(6) Genetic information.
‘‘(7) Evidence of insurability (including conditions arising out of acts of domestic violence).
‘‘(8) Disability.
‘‘(9) Any other health status-related factor determined appropriate by the Secretary.
"Any other health status-related factor determined appropriate by the Secretary" -- delicious! Given her track record, I'm thinking we're going to enjoy Sebelius' take on "appropriate." My deepest apologies to all Kansans, but your loss is the country's gain. She's a fighter who's kickin' ass and taking names. Thanks, guys!
Update [2010-4-24 14:55:12 by Cedwyn]: Additional useful info on the specifics of the bill in this comment thread, for those who don't tend to wade into the comments section.