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Wednesday, October 20, 2010

The proof is in the denials

Kate Blocher

Staff Writer

Attorneys General from a handful of states want to repeal the new health care law to gain political points. These opponents of reform want to undo all the hard-won benefits achieved by the passage of the Affordable Care Act and dismantle the myriad consumer protections the bill has put in place for hard-working American families and businesses.

As if we needed further proof, it became abundantly clear last week just how necessary the consumer protections in the Affordable Care Act are, when the Energy and Commerce Committee released information on an investigation into four major insurers (Aetna, Humana, UnitedHealth Group, and WellPoint) on their denial rates of people with pre-existing conditions.

The investigation, lead by Democrats Henry A. Waxman of California and Bart Stupak of Michigan, revealed that while insurers saw a 16 percent increase in the number of applicants,  there was a dramatic 49 percent spike in the number of individuals who were denied health insurance coverage due to a pre-existing condition between the years of 2007-2009.  According to the report, between 2007 and 2009, these insurance companies denied more than 651,000 Americans coverage in the individual insurance market because of their medical history. Those numbers are unconscionable.

As if the statistics aren’t shocking enough, the investigation uncovered strategic business practices aimed at either excluding individuals with certain medical histories from coverage entirely, or strictly limiting the amount they would pay out on medical claims.

According to the investigation, “From 2007 through 2009, Aetna, Humana, UnitedHealth Group, and WellPoint refused to pay 212,800 claims for medical treatment due to pre-existing conditions.” Many of the insurers would accept individuals with pre-existing conditions, but would then attach medical riders to either exclude coverage for the pre-existing condition or increase their deductible. Even though they were technically covered, they would still be responsible for out-of-pocket costs that were financially out of reach.

Each of the companies investigated had specific business plans that used pre-existing conditions to limit the amount of money they would pay out in medical claims. Whether it was strengthening their underwriting process to exclude more people or lengthening their look-back period, there was a concerted effort on the part of the insurance industry to make it increasingly difficult for those with pre-existing conditions to find and keep health coverage in the individual market.

One of the major tenets of the Affordable Care Act is finally holding the insurance industry accountable for some of their most atrocious business practices, the most heinous being the denial of coverage due to pre-existing conditions. This investigation only further underscores the need for this reform, because without it, these practices would continue unabated. And to those who are actively seeking to repeal the law, they are only speaking out in favor the insurance industry, not for the American people who have been routinely denied and dropped from coverage.