Put yourself in Ian Pearl's position. You were diagnosed with muscular dystrophy shortly after your birth and have been confined to a wheelchair since you were six years old. Even though you were physically disabled, your brain is fully functional and you are striving to be the best you can be.
But then it happens. At 19 years old, you have a life-threatening complication that leaves you with one option: If you are to live, you must breathe with the help of a ventilator.
And through it all, through the life-threatening complications you had to endure along the way and through everything you have been through since you were born, who would have thought that it was a health insurance company that could be the thing that kills you.
Ian's story is better told by him, but here's the summary: Guardian decided that they were sick of covering Ian. At first, they pulled the health care plan that covered everyone in his dad's company in New York. That could be seen as a general move not targeted at Ian, but with some digging, Ian found that it was because of him and others with serious medical issues that Guardian made this decision. According to Ian's account on Huffington Post, Guardian created a "hit list" of their insured customers who were costing them the most to cover. These members were referred to by Guardian's top officials as "dogs" and "trainwrecks" because of their health conditions and their cost to insure. Ian was one of many targeted by Guardian, a process that included certain members like Ian having private investigators look for anything to cancel the plan so Guardian could save money.
It's not like Guardian couldn't afford to cover Ian and others in similar situations (from Ian's post):
While all this was going on, Guardian reported $7.5 billion revenue, net income of $437 million, and available capital of $4.3 billion in 2008. Unlike small businesses, Guardian's financial strength remained unscathed by the economic downturn.
What Guardian did was remove a plan they offered from an entire state all because of a select few of their insured who were seen as too costly.
Enter Senator Eric Schneiderman, who introduced S6263 or "Ian's Law" in the New York State Senate. The bill "provides enhanced consumer protections in the event of an insurer's discontinuance of coverage, including requiring approval of the superintendent and notice to policyholders." Specifically, it would prohibit insurance companies from doing what Guardian did: Canceling a whole class of a policy they were offering. With Ian's Law, the insurance company could not cancel this plan unless they received approval from the state Insurance Department.
How is this law different from current law? Currently, it is illegal to cancel someone's insurance because they have chronic health problems like muscular dystrophy. Thus, it would have been (or perhaps IS) illegal for Guardian to cancel Ian's policy. But nothing prevents them from pulling a whole class of insurance. Of course, if they did so because of those who they insure that have chronic health conditions, that IS illegal and should be dealt with and the individuals responsible should not just be held liable via civil action, they should also face criminal charges. Because in the case of Ian Pearl, this is life and death. And when insurance companies are playing games with people's lives, they should face serious punishment.
For more on this story, watch the video below from yesterday's press conference introducing Ian's Law. The full text of the bill is below the fold.
This bill would prevent health insurance companies from doing what Guardian did: Pulling coverage in the name of profit. That was the motive in the case of Ian and others. They were seen as "dogs" and "trainwrecks" because they were actually in need of their insurance and thus costing Guardian. Not that Guardian was hurting for the money. They still have their billions. But they wanted more. So they put Ian in a situation where he is now fighting for his life.
Ian's Law is important and while it would only apply to New York, it should be a law that every state introduces and passes and should become a federal law so that we can prevent insurance companies from deciding who they want to cover and who will be the cheapest to cover.
The story of Ian Pearl is one that should anger every citizen. Ian was born with muscular dystrophy. Since that diagnosis, which came shortly after his birth, he has lived through a number of setbacks and life-threatening complications.
But what happened to Ian should not happen to any American. I will let Ian's own words tell the story:
After decades of medical emergencies, we still weren't prepared for the latest crisis -- this one created by the same insurance company that once saved my life. Guardian abruptly withdrew our health plan from all policyholders in New York where my father's business is based. Guardian offered a 'replacement' plan with low benefits and no home nursing benefits. They knew that I would never survive with such a plan, but they didn't care.
Suspecting that this action was related to the high cost of my care, we filed a lawsuit and have asked the U.S. Department of Health and Human Services to enforce existing federal laws and require Guardian to continue my health plan. Without federal intervention, I will lose this insurance, and that would be a death sentence.
Our lawsuit uncovered insurance company documents that confirmed my suspicion that I'm a target of discrimination. The documents revealed Guardian had compiled a "hit list" of its costliest members, including patients with muscular dystrophy, multiple sclerosis, brain injury, and paralysis. Guardian executives referred to us all as "dogs" and "trainwrecks," and they debated how and when to dump us from the rolls. Laws prohibited the cancellation of the individual members with serious chronic health problems, so Guardian opted to cancel the plan for all members of this specific health plan in New York, an action that violates federal law.
Because of this, Senator Eric Schneiderman announced yesterday that he was introducing S.6263 in the New York State Senate. The bill will be called Ian's Law and would protect those like Ian who are denied coverage they need by companies who don't feel like covering them.
Joined by patients and insurance reform advocates, Senator Eric T. Schneiderman (D-Manhattan/Bronx) announced the introduction of major legislation today that protects patients from egregious insurance industry practices. "Ian's Law" (S.6263) makes it illegal for insurers to drop entire classes of insurance as a pretext to deny coverage to individual policyholders; requires insurance companies to get prior approval from the Insurance Department before discontinuing a class of insurance; and expands the minimum length of time - to 18 months - that an insurance company must ensure that policyholders with total disabilities receive continued coverage after losing their policy due to the statewide cancellation of an entire class of policies.
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Ian's Law requires insurers to prove they are not dropping a line of coverage as a pretext for dumping an individual policyholder. That means:
Insurers must get permission from the Insurance Department to drop a line of coverage - and notify impacted policyholders when they apply.
Insurers must show the following to the Insurance Department: the claims and premium rates for each policy issued in the class, the historical profits and losses for the line of policies, and any other information requested by the Department. The Department must look at this information to determine if the dropping of a class of policies statewide is merely a pretext for dropping coverage of a particular individual.
Policyholders are given an opportunity to comment on the impact of the dropped policies, and the Insurance Department must take these comments into account.
Ian's Law also empowers consumers to challenge insurance companies in court if they discontinue lines of coverage in violation of the new law. In addition, policyholders with severe disabilities will receive at least 18 months of coverage if they lose their policies due to the cancellation of a class of policies. (Current regulations require such care for only 12 months.)
What happened to Ian Pearl should not happen to anyone. This should not only be a New York State law, but it should also be a federal law. Hopefully, the state legislature acts quickly on Ian's Law and in turn, motivates other states and the federal government to take action.
