Health Insurance Consumer Information

Amy Harmon of the New York Times writes today about Congress’s overwhelming vote on May 1, for a bill that prohibits discrimination by health insurers and employers based on a person’s genes.

This Genetic Information Nondiscrimination Act protects consumers and prevents insurance companies from using genetic information to deny benefits or raise premiums for individual policies, and prevents employers from hiring, firing or setting compensation based on genetic information.

The implications of this bill, should it become law, may continue to have a positive impact on the healthcare situation for all Americans. The story quotes Karen Pollitz, director of the Health Policy Institute at Georgetown University and head of the healthinsuranceinfo.net project:

“Ultimately unlocking all these genetic secrets will make the whole idea of private health insurance obsolete.”

Read the story online: Congress Passes Bill to Bar Bias Based on Genes, New York Times, May 2, 2008.

For more background information, Professor Pollitz’s 2007 paper, Genetic Discrimination in Health Insurance: Current Legal Protections and Industry Practices, from the journal Inquiry, is helpful.  You can order back copies from Inquiry via the link above.

Two recent stories in the New York Times featured the healthinsuranceinfo.net website and its free consumer guides. Whether you are self-employed or facing retirement, these articles can provide some advice and perspective on your situation and stories of others in your situation.

Before Medicare, Sticker Shock and Rejection by Fred Brock, April 21, 2008. Pointing out that only a third of employers now offer retiree health benefits, the article discusses some of the technical aspects of getting health insurance if you retire before you are eligible for Medicare and can’t afford COBRA rates for your employer’s health insurance, covering topics like guaranteed issue, premiums and deductibles, some of the ins and outs of COBRA and HIPAA, and high-risk pools.

The article states: “If you have no pre-existing medical conditions (however that is defined by your prospective insurance company), buying individual insurance should not be hard in a state without guaranteed-issue laws.” healthinsuranceinfo.net provides current information on state insurance rules.”

Finding Health Insurance If You Are Self-Employed by Marci Alboher, March 27, 2008. “These [state-by-state consumer guide] primers are comprehensive and frequently updated, and they are a great place to start, especially if you have been wondering about the meaning of jargon that peppers insurance providers’ descriptions of their offerings,” according to Alboher and one of her subjects, Jennifer Jaff.

This website was featured in a recent New York Times Business story.

“Jennifer Jaff, a reader who happens to be an expert on health insurance issues, shared a valuable tool, healthinsuranceinfo.net. The site, maintained by the Georgetown Health Policy Institute, shows a map of the country and after clicking on a state, a document is downloaded that covers everything from what kinds of programs are available to small-business owners to whether there is a high-risk pool available for those who have been rejected by insurance providers. These primers are comprehensive and frequently updated, and they are a great place to start, especially if you have been wondering about the meaning of jargon that peppers insurance providers’ descriptions of their offerings.”

Read the whole story, which offers many other tips and cautionary tales for those entering the insurance market alone, at the New York Times Web site: Health Insurance If You Are Self-Employed by Marci Alboher, March 27, 2008.

A new study from the Kaiser Family Foundation says states that allow insurance companies to limit eligibility or increase premiums due to a person’s health history contribute to an increase in the number of uninsured. In 2004, Indiana passed a law allowing insurers to deny coverage due to pre-existing conditions, promoting that law as a measure to help decrease the number of uninsured. But the number of uninsured in the state has not decreased, and the rising costs of healthcare have contributed to the insurance problem, as even those who qualify cannot always afford to pay for coverage.

The article quotes Karen Pollitz, project director at Georgetown University’s Health Policy Institute, as saying:

“It’s a really difficult market for everybody. It’s like an onion; there are all sorts of layers of difficulties. If one of the difficulties doesn’t trip you up, another one will.”

Read the full article online at Indystar.com: Health insurance law misses goals (Feb. 27, 2008).

Are you in Indiana and wondering what options you have to get health insurance? Our free online guide can help you make an informed choice: Guide to Getting and Keeping Health Insurance in Indiana (last updated January 2006).

The Washington Post’s recent feature “Uninsured? You’re Not Alone” highlighted the resources available here at healthinsuranceinfo.net. The article clearly, and succinctly, covers the options available to Washington, D.C., Maryland and Virginia residents who need to buy individual health insurance. Additionally, healthinsuranceinfo.net’s director, Karen Pollitz, talked with readers on the newspaper’s website.

Transcript of Karen Pollitz’s washingtonpost.com online chat

Washington Post article

The specific resources on this website, cited by the article, are:

Consumer Guides for Getting and Keeping Health Insurance: Washington, DC | Maryland | Virginia | all other states

Options for Avoiding and Managing Medical Debt ( PDF format, 33 pages, 616 KB)

Several states are investigating and considering actions to regulate the practices of limited- or scheduled-benefit plans being offered by HealthMarkets and its subsidiaries, Mega Life, Mid-West National and Chesapeake Life. Regulators say they have received a higher-than-normal rate of complaints about poor coverage and deceptive sales practices from these insurers.

While some analysts say that these low-coverage policies are better than nothing for sick consumers, the question remains of whether limited-benefit coverage policies, which set tight limits on what, and how much, the insurer will pay, are offering policyholders enough financial protection to be considered “insurance” at all.

As quoted in a recent USA Today story, Georgetown University Health Policy Institute’s Mila Kofman says: “The idea behind being privately insured is that your insurance company will pick up the bills when you’re sick, not for government programs to pick up the bills after you’ve paid premiums to the insurer … By the time a consumer realizes they don’t have a major medical policy, it’s too late.”

Read the original story at USA Today’s website: Limited policies vex some buyers.

A recent NPR story covered the history of the last decade of health care reform and HIPAA. The law, which was passed in 1997, was intended to allow individuals to keep health care coverage even when their employment status changed. However, most observers say that it hasn’t turned out that way.

“There’s just really not a guarantee that you’re going to have comparable coverage at a comparable price” when you leave your previous employer and go to a new one or go to work for yourself, says Karen Pollitz, the director of Georgetown University’s Health Policy Institute programs on health insurance.

Joanne Silberner’s story was presented on Morning Edition – you can listen at the NPR website.

US News and World Report published a story earlier this week quoting project director Karen Pollitz, which uncovered the unsavory hard truths about health insurers who deny coverage for pre-existing conditions, and deny policies based on pre-existing conditions.

As Pollitz notes, some in the business community say that pre-existing condition exclusions may be intended to encourage people to get insure before they are sick, rather that waiting until they are sick when their conditions will cost insurers more.

“It’s a penalty for waiting to get insurance,” says Pollitz. “But a lot of people didn’t wait. They had coverage, and they lost it.”

The article also contains advice to consumers about keeping group health insurance if at all possible.

Read it at the US News and World Report website: Health: An Ailment Could Delay or Rule Out Healthcare Coverage.

Mila Kofman, Associate Research Professor at Georgetown University’s Health Policy Institute, was quoted in a Wall Street Journal story on one Utah company’s proposal to market discriminatory health insurance practices to US businesses.

Commenting on the entrepreneur’s business idea, which is that employers should drop group health insurance coverage for their employees and instead provide individual insurance policies for eligible employees, Kofman said:

“I think this is blatantly illegal … I would not advise any employer to do this.”

Read the story online: Employers Turn to Alternative for Insuring Staff.

Karen Pollitz, Project Director of the Health Policy Institute at Georgetown University, spoke to USA Today about a new set of high-deductible health care plans being offered by United Healthcare and others.

These plans offer financial incentives, in the form of significantly lower deductibles, for enrollees who submit to health tests that show they fall into generally healthy standards. This is advertised as promoting healthy lifestyles which in turn can lower illness rates in some categories. But do the damaging consequences to privacy and potential discrimination against the less-than-healthy, outweigh the benefits?

“A key protection in the Americans with Disabilities Act is that your employer can’t discriminate against you based on health status,” says Karen Pollitz at the Georgetown University Health Policy Institute. “They can’t even ask about your health, with the only exception being if they ask through a voluntary program. You could argue that this program is not voluntary.”

Read the story at the USA Today website: Plan bases deductible on health tests, sees costs fall.