Healthcare Insurers: I Think the Appropriate Word is “Disturbing”
August 14th, 2009 | Paul Secunda
Washington Post’s Daily Dose Blog adds more fuel to the health care reform debate:
The Department of Health and Human Services put a spotlight on that practice Tuesday in its continuing campaign to build support for an overhaul of health insurance.
“When a person is diagnosed with an expensive condition such as cancer, some insurance companies review his/her initial health status questionnaire,” the HHS said in a posting at HealthReform.Gov. In most states, insurance companies can retroactively cancel individuals’ policies if any condition was not disclosed when the policy was obtained, “even if the medical condition is unrelated, and even if the person was not aware of the condition at the time.”
“Coverage can also be revoked for all members of a family, even if only one family member failed to disclose a medical condition,” HHS said.
The department cited recent research by the staff of the House Committee on Energy and Commerce, which found that three large insurers rescinded almost 20,000 policies over five years, saving $300 million in medical claims.
At least one insurer included such savings in an employee performance evaluation.
I teach a case in employee benefits law class, McGann v. H&H Music (5th Cir. 1992), that describes a similar practice to this. Unfortunately, the court in McGann found that the participant could not prevail under an ERISA Section 510 retaliation claim when his coverage was dramatically reduced (1 million to $5000) when he told his employer he had AIDS.
Maybe I’ll just start counting reasons why health care reform is a necessity and that health insurers cannot continue to exist in a world with little regulation and even less meaningful remedies against them for this type of disturbing conduct.
The employee performance part can be filed under “truly disturbing.”
Paul Secunda: Paul Secunda joined the Marquette University Law School as an associate professor of law in the summer of 2008. He teaches employment discrimination, employee benefits, labor law, employment law, civil procedure, and seminars in special education law, global issues in employee benefits, and public employment law. Professor Secunda is the author of nearly three dozen books, treatises, articles, and shorter writings. He is also the author, along with Rick Bales and Jeff Hirsch, of the treatise, Understanding Employment Law, along with Sam Estreicher and Rosalind Connor, of the case book, Global Issues in Employee Benefits Law, and of the Teacher’s Manual to the 14th Edition of the Cox, Bok, Gorman & Finkin Labor Law casebook.Professor Secunda is a frequent commentator on labor and employment law issues in the national media and has written numerous columns and op-eds for the National Law Journal and Legal Times. He co-edits with Rick Bales and Jeffrey Hirsch the Workplace Prof Blog, recently named one of the top law professor blogs in the country, which is part of the Law Professors Blog Network.
This article originally appeared on Workplace Prof Blog and is reprinted here with permission from the author.
Related Posts:
Tags: health care, healthcare, Insurance, Paul Secunda, Workplace Prof Blog
August 14th, 2009 at 5:41 pm
At this point, although the debate and spin continue, this bill is essentially dead from an emotional and mandate perspective, even if some version gets passed. Whether it ultimately proves to be of any benefit to society, or a detriment, will take years, if not decades, to appreciate.
This bill, and virtually anything that might be done to improve our healthcare system, involves too much complexity with which we are emotionally motivated to deal. In addition, there are too many factions with entrenched economic and/or financial interests to permit it to become a true health initiative.
There’s been too much arguing about the details. People can not describe in 2 or 3 sentences the conceptual parameters of the effort and what it is supposed to accomplish. Unfortunately, people can describe how they feel about it in 1 or 2 words, and that’s not good. And that’s not to mention the elements who have whipped up hysteria by suggesting, with certainty, what will occur once the final product (which does not yet exist) emerges.
If either side of the debate has to work this hard arguing about something which theoretically should improve the lives of the masses of people, there’s a big problem.
Even more so than how something is done, people are interested in results, not the details. And once again, as is frequently the case with much of human processing, the facts don’t really matter. How people view the world, what they value, and what they want, matters.
And there is nothing collaborative in nature about that. Factor in the strong individualistic American DNA, and this effort is emotionally toast.