Pre-existing conditions....the "gotcha" of the healthcare industry!

From John Curry, March 24, 2008
Subject: Pre-existing conditions....the "gotcha" of the healthcare industry!

Courant.com
Health Care Exclusions Targeted
By DIANE LEVICK
Courant Staff Writer
Hartford, CT March 21, 2008

As a diabetic, Rita Gould of Killingworth knows all too well the problem posed by "pre-existing conditions" when it comes to health insurance. It cost her a lot of worry and $1,242 a month in premiums.

So it was no surprise that she was among those championing a congressional bill on the matter at a hearing in Hartford Thursday that was co-hosted by the bill's author, U.S. Rep. Joe Courtney, D-2nd District.

Courtney's bill is meant to reduce the instances in which an insurer can refuse to cover pre-existing conditions — health problems such as asthma, diabetes and cancer that a person had before being insured by that company.

Pre-existing conditions can make it impossible for many people to find or afford insurance. The situation leaves many people uninsured, incurring ruinous medical bills and sometimes postponing or skipping care they should get. The issue is part of the nation's debate over health care reform and has surfaced in the presidential campaign.

"The unnecessarily unfair treatment of individuals suffering from chronic or debilitating conditions by the health insurance industry must end," Courtney said after the hearing. "Over 1 million Connecticut residents suffer from a chronic illness or a debilitating condition, and they need our help," he added.

Gould's problem arose last year when the extension of her retired husband's insurance ran out and she needed a six-month policy to tide her over until she reached 65, when Medicare kicks in. Gould, who was an adjunct professor at Central Connecticut State University, got turned down by various companies, including one endorsed by AARP, and ended up in a statewide pool of last resort, paying the $1,242 a month.

Courtney's bill is aimed at helping people who are moving from one employer's health plan to another or are switching from an employer's health plan to an individual health insurance policy.

"This story has a moral dimension and an economic dimension," said U.S. Rep. Rob Andrews, a New Jersey Democrat. He was co-chairman of Thursday's "field hearing," which featured six pre-designated witnesses, but did not take testimony from the public.

Andrews and Courtney serve on the House Education and Labor Committee. Andrews is the chairman of the committee's Subcommittee On Health, Employment, Labor and Pensions.

"In a country as powerful and wealthy as this one, where someone who has breast cancer, diabetes or HIV or some other condition, not to get health care coverage because of some arbitrary waiting period is outrageous and needs to be fixed," Andrews said.

The bill (HR2833) would go further than the 1996 federal Health Insurance Portability and Accountability Act, which put some limits on insurers' restrictions on coverage for pre-existing conditions.

Under the bill, a person changing health plans could be subject to a three-month waiting period under the new plan for coverage of pre-existing health problems, instead of 12 months under current federal law.

Also, an insurer could look back at only 30 days of a person's health record to determine whether there are pre-existing conditions subject to the waiting period, the bill says. Currently a six-month "look-back" is allowed.

Andrews said that about 7.2 million Americans are uninsured because of pre-existing conditions, and the bill could help more than 5 million of them. However, tightening the exclusions of pre-existing conditions will leave insurers with more claims, and they're likely to pass on the added cost by raising premiums.

Contact Diane Levick at dlevick@courant.com.