Research Paper: Pre-Existing Condition and Denial

Pages: 10 (2741 words)  ·  Bibliography Sources: 10  ·  Level: College Senior  ·  Topic: Healthcare  ·  Buy This Paper

SAMPLE EXCERPT:

[. . .] Rockefeller IV and President Obama stated that beginning in 2010 that insurance companies "will be banned from denying insurance coverage to children with pre-existing conditions." (New York Times, 2010)

The New York Times report states "The authors of the law say they meant to ban all forms of discrimination against children with pre-existing conditions like asthma, diabetes, birth defects, orthopedic problems, leukemia, cystic fibrosis and sickle cell disease. The goal, they say, was to provide those youngsters with access to insurance and to a full range of benefits once they are in a health plan." (2010) However, according to the report "To insurance companies, the language of the law is not so clear. Insurers agree that if they provide insurance for a child, they must cover pre-existing conditions. But, they say, the law does not require them to write insurance for the child and it does not guarantee the "availability of coverage" for all until 2014." (New York Times, 2010)

According to William G. Schiffbauer, a lawyer whose clients include employers and insurance companies "The fine print differs from the larger political message. If a company sells insurance, it will have to cover pre-existing conditions for children covered by the policy. But it does not have to sell to somebody with a pre-existing condition. And the insurer could increase premiums to cover the additional cost." (New York Times, 2010)

Democrats in Congress are reported to have been very upset "…when they learned that some insurers disagreed with their interpretation of the law." (New York Times, 2010) According to Representative Henry A. Waxman, Democrat of California and chairman of the Energy and Commerce Committee, "The concept that insurance companies would even seek to deny children coverage exemplifies why we fought for this reform." (New York Times, 2010) Senator John D. Rockefeller IV, Democrat of West Virginia and chairman of the Senate commerce committee, is reported as having stated, "The ink has not yet dried on the health care reform bill, and already some deplorable health insurance companies are trying to duck away from covering children with pre-existing conditions. This is outrageous." (New York Times, 2010)

The New York Times report states of the issue that it is

"…one of many that federal officials are tackling as they prepare to carry out the law, with a huge stream of new rules, official guidance, and brochures to educate the public. Their decisions will have major practical implications. Insurers say they often limit coverage of pre-existing conditions under policies sold in the individual insurance market. Thus, for example, an insurer might cover a family of four, including a child with a heart defect, but exclude treatment of that condition from the policy." (2010)

According to the new law "…health plans and insurers offering individual or group coverage "may not impose any pre-existing condition exclusion with respect to such plan or coverage" for children under 19, starting in "plan years" that begin on or after Sept. 23, 2010." (New York Times, 2010) However, according to insurance companies "…until 2014, the law does not require them to write insurance at all for the child or the family. In the language of insurance, the law does not include a "guaranteed issue" requirement before then." (New York Times, 2010)

The new law, once disseminated, actually states that beginning in January 2014 "…health plans will be required to accept everyone who applies for coverage. Until then, people with pre-existing conditions could seek coverage in high-risk insurance pools run by states or by the secretary of health and human services. The new law provides $5 billion to help pay claims filed by people in those pools." (New York Times, 2010)

It is reported that some states have used high-risk pools to cover those who are medically uninsurable and that these high-risk pools quite simply "do not work.' (New York Times, 2010) Stated in one report is the fact that thirty-five U.S. states make offerings of high-risk pool for individuals who have been denied coverage in the individual insurance market or otherwise cannot obtain insurance, however

"high-risk pools generally charge significantly higher rates than they charge for a healthy individual in the individual insurance market, meaning that only relatively high-income people can afford the coverage. One study estimated that only eight percent of the uninsurable population is able to enroll in high-risk pools, mainly because of high premiums. Benefits through a high-risk pool are also not guaranteed. Some state high-risk pools have annual caps on enrollment, or limit eligibility only to people who had prior group health coverage in the preceding 63 days. And one state high-risk pool has been closed to new beneficiaries since 1991. (HealthReform.gov, 2011)

In addition, all high-risk pools create an imposition of pre-existing condition exclusions for approximately six months to one year and during this time; the uninsurable condition that caused the individual to be uninsurable is not covered.

V. The Solution

It is clear that health insurance reform is needed toward providing stability and security for all Americans and health insurance reform should include a prohibition on insurance companies from refusing coverage due to the individual's medical history or health related risk. In addition, health insurance companies should be required to renew any policy as long as the premium is paid in full by the policyholder. Prohibitions should be placed on insurance companies, which will bar them from refusing renewal due to sickness and from "dropping or watering down insurance coverage for those who are or become ill." (HealthReform.gov, 2011)

Summary and Conclusion

Abuses of insurance companies of the process of rescission needs to be addressed by law and policymakers and individuals, most particularly children, with pre-existing conditions should not be denied health insurance coverage. The insurance companies in collusion with employers are awarding employees for not using insurance coverage on their conditions and conditions, which historically have not been held as pre-existing conditions, are being regulated to the category of a pre-existing condition by insurance companies. It is clear that regulatory and legislative reform needs to address the practice of insurance companies denying insurance coverage and insurance claims on the basis of pre-existing conditions.

Bibliography

At Risk: Pre-Existing Conditions Could Affect 1 in 2 Americans. (2010) Health Care. Retrieved from: http://www.healthcare.gov/law/resources/reports/preexisting.html

Coverage Denied: How the Current Health Care Insurance System Leaves Millions Behind. (2011) HealthReform.gov. Retrieved from: http://www.healthreform.gov/reports/denied_coverage/index.html

Coverage Denied: How the Current Health Insurance System Leaves Millions Behind (nd) Health Reform. Retrieved from: http://www.healthreform.gov/reports/denied_coverage/index.html

Health Care Reform Bill 1010: Rules for Pre-existing Conditions. (2010) The Christian Science Monitor. 24 Mar 2010. Retrieved from: http://www.csmonitor.com/USA/Politics/2010/0324/Health-care-reform-bill-101-rules-for-preexisting-conditions

HHS to Reduce Premiums, Make it Easier for Americans with Pre-Existing Conditions to Get Health Insurance (2011) Department of Health and Human Services. 31 May 2011. Retrieved from: http://www.hhs.gov/news/press/2011pres/05/20110531b.html

HHS to Reduce Premiums, Make it Easier for Americans with Pre-Existing Conditions to Get Health Insurance (2011) U.S. Department of Health and Human Serivces. 31 May 2011. Retrieved from: http://www.hhs.gov/news/press/2011pres/05/20110531b.html

Jarvis, Jan (2010) Crowley Newborn with Heart Defect is Denied Insurance Coverage. 26 Mar 2010. Star-Telegram. Retrieved from: http://www.star-telegram.com/2010/03/25/2068267/crowley-newborn-with-heart-defect.html

Jilani, Zaid (2009) Six-Year-old Girl 'On Verge Of Never Hearing Again' Due To Insurance Company Denial. TP News. 19 Nov 2009. Retrieved from: http://thinkprogress.org/politics/2009/11/19/70233/insurance-denies-little-girl/

Pear, Robert (2010) Coverage Now for Sick Children? Check Fine Print. New York Times. 28 Mar 2010. Retrieved from: http://www.nytimes.com/2010/03/29/health/policy/29health.html

Woman Who Was Denied Insurance Due to Pre-Existing Condition Looking to Get Married for Health Care. (2010) TP. 1 Feb… [END OF PREVIEW]

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