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November 19, 2009
The Senate Bill and Rescissions
If you feel like wading through the 2,000 pages, here's the full bill. The summaries are here. I noticed that the public option isn't mentioned in the main summary.
One huge thing jumped off the page in the "immediate assistance" summary. Huge in a very troubling way.
Protection from Rescissions of Existing Coverage
The Patient Protection and Affordable Care Act will stop insurers from rescinding insurance when claims are filed, except in cases of fraud or intentional misrepresentation of material fact.
That's not really a ban on rescissions. "Fraud and intentional misrepresentation of material fact" are precisely the excuses that the insurance companies are using when rescinding policies. Does the Senate actually believe that the insurance companies are telling people that their policy is rescinded because the got sick? No way.
They always claim that it's due to fraud or misrepresentations. For example, one of the many horror stories involves a woman's policy being rescinded because she didn't report a prior case of acne. Her insurance company interpreted this as fraud and rescinded the policy. Fraud! The ban on rescissions is supposed to prevent this.
So how does the Senate bill differentiate between the two? If they intend to make these exceptions, I hope there's some form of regulatory enforcement and investigation unit to serve as a backstop to determine, for example, what "misrepresentations" are intentional or not. But what they ought to do is ban rescission entirely. If there's a case of fraud, maybe enforce some kind of penalty. Don't take away a sick or injured person's healthcare!
I'd love to ask Harry Reid about this whopper. Seriously, we need the Senate to fix this. And come to think of it, I wonder if this language is in the House bill as well.
Filed under: Healthcare || Public Option || Rescissions || Senate
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Posted By Bob Cesca | November 19, 2009 7:31 AM
Comments
There are many loopholes in this thing like this. Anyone who thinks the ins. companies will just obey the law and not kick people out or deny coverage is nuts. it will be business as usual and will be left up to us to fight the ins. companies. I mean, who are we going to call? Harry Reid?
There needs to be enforcement mechanisms in every state-and maybe there will be-but I can't find it anywhere yet. Perhaps the insurance commissions in each state will be tasked with enforcement.
And for us with a rethug governor with presidential aspirations and 1 term limited? Well, we're just screwed. I'm trying to find the safety net for us in this state whose governor will most likely opt us out.
I'm still reading and looking.
Posted by: Jan ![[TypeKey Profile Page]](http://www.bobcesca.com/nav-commenters.gif)
at November 19, 2009 9:08 AM
But the bill is also supposed to stop ins cos from denying coverage due to preexisting conditions. I think that should eliminate their angle of fraud. If they can't deny or drop you because of a preexisting condition, forgetting to mention the acne from your teen years would no longer constitute fraud.
Me thinks you be overreacting a bit. The bill is far from perfect, and I would certainly prefer a single payer system. However, even if this were ever to be an issue it seems a relatively easy tweak down the road. There will be plenty of those anyway.
Posted by: zaphod beeblebrox at November 19, 2009 9:36 AM
If they can't deny or drop you because of a preexisting condition, forgetting to mention the acne from your teen years would no longer constitute fraud.
All I'm saying is who is going to make sure they don't deny or drop you?
Do we really think come 2013 the insurance companies are going to follow the letter of the law and be all fair and shit? Without enforcement or monitoring?
Posted by: Jan at November 19, 2009 9:45 AM
What I mean is this... What if I forget to note an injury on my application form. The insurance company might still be able to rescind my policy based on a trumped up accusation of fraud if they find out about that injury later on.
Posted by: Bob_Cesca at November 19, 2009 10:16 AM
Oh, I get what you're saying, Jan. But I don't see any language preventing someone from being "dropped" for a pre-existing condition. So far, it only looks like they can't deny a new policy based on those conditions.
All in all, it seems like it would be fairly easy for an insurance company to trump up charges of fraud or misrepresentation -- as they have been for a while now.
Posted by: Bob_Cesca at November 19, 2009 10:20 AM
yup Bob.
imho way too much wiggle room for the ins. companies.
Guess we'll find out as this goes on down the road.
Posted by: Jan at November 19, 2009 11:11 AM
I just contacted Sherrod Brown about it.
Does the "ban" on pre-existing conditions go into effect as soon as the bill is passed or do we wait until 2013? What about Medicaid expansion?
Posted by: jtravisrolko at November 19, 2009 1:12 PM
Considering pre-existing conditions will be off the table, then what would be fraudulent? The only things to lie about would be previous health issues and since those would be moot, then fraud should be moot by default.
Jennifer
Posted by: jhw22 at November 19, 2009 2:40 PM
Just read the comments AFTER I posted mine. I think we're all in agreement. :)
Jennifer
Posted by: jhw22 at November 19, 2009 2:40 PM
