GAZETTE COLUMN: DENIED HEALTH INSURANCE COVERAGE BECAUSE YOU WERE SICK? THAT’S WRONG! by John P. Flannery

You may have health insurance now but can you keep it and can you be insured if you change jobs or, worse, become unemployed?

One of the significant bars to getting “new” insurance is a “pre-existing health condition?” 

According to the Department of Health and Human Services, anywhere from 50 million to 129 million non-elderly Americans have “pre-existing health conditions.”

It could be acne, hemorrhoids, toenail fungus, allergies, tonsillitis, bunions, but also chronic conditions including heart disease (affecting every third adult), cancer (affecting about 11 million Americans), diabetes, asthma, hay fever, lung disease, or a sports injuries; domestic violence is a pre-existing condition (in nine states).  It can even be a disease you’ve never had.  For example, if you have hay fever, you could have respiratory system diseases including bronchitis or pneumonia, and this possible affliction is treated as “pre-existing.”

Health Insurance companies in Virginia may discriminate against you if you have a pre-existing condition and seek to buy insurance in the individual insurance market.  This is particularly important when job-based health insurance group policies are declining, when those who separate from their employer can’t always afford the job-related insurance available under COBRA, and when we still have high unemployment.

Pre-existing conditions prompt insurers to charge higher premiums, demand larger deductibles, require bigger co-pays, set life-time benefit limits, and bar coverage entirely.

One 45-year old real estate agent had a kidney transplant and, afterwards, lost his insurance because he overlooked to complete a health questionnaire.  He couldn’t get new health insurance coverage to pay for the critical immunosuppressant medication required to guard against his body’s rejection of the new kidney; he had to pay $2,000 a month out of pocket.

The health insurance reform legislation passed by the U.S. Congress in 2010, the Patient Protection and Affordable Care Act, HR 3590, signed into law by President Barack Obama, prevents insurance companies from refusing insurance because of your medical history or health risk.  Insurers also have to renew your policy provided you pay the premium, and they may not deny renewal or dilute coverage because you got sick.  But the rub is that this reform does not go into effect until January 10, 2014. 

Meantime, insurance companies, their lobbyists and our compliant public officials, are demanding this health reform be repealed.

One principal argument they make is that this health reform requires those who can afford health insurance to pay for insurance policies. 

The reason is that those who are healthy, if not required to buy insurance, could otherwise stay out of the insurance pool until they are sick and then free load on this reform granting them insurance coverage for any pre-existing condition. 

This program will only work if the insured pool is large, encompassing both those with relatively few claims (mostly the young and healthy), as well as those with serious medical challenges; in other words, only if the fund’s paid in premiums exceed the medical insurance claims that we file.

We need a law mandating insurance coverage for those with pre-existing conditions; a mandate that those who can afford health coverage get health coverage, and we have to resist those who would repeal this critical protection.