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.
I listen to too much talk radio, in part because there's no decent music radio around here (Albany, NY, and I can't get WEQX well) and mostly because I'm interested in almost any discussion of national, state or local issues.
I hardly ever call into the few local talk shows, but yesterday I did.
And it sucked, big time.
The issue for three hours on Dan Lynch's afternoon show on WGDJ-AM was health insurance reform.
I thought I had something to add, based on two bloggy things I'd read, about one reason for-profit health insurance cannot compete with any real public option -- the obscene compensation of insurance company CEOs compared to the much more modest compensation of government health insurance executives.
So I called, and was derided as "far left" and "socialist" by the allegedly moderate host.
Today, Citizen Action NY released a report documenting how contributions to influential Republican NYS Senators, Senate Leadership and party Committee coffers is allowing insurance companies to jack rates NYers pay, while pocketing record profits.
Now, I'm a cynic when it comes to NYS Legislature's pay-to-play system. But, even I was shocked by this report, titled "The High Cost of "Pay-to-Play": Health Insurance Contributions Drive Up Insurance Rates".
Partly because the dollars contributed were so skewed-- way more to the Republicans in the Senate, who obligingly block legislation from leaving the Insurance Committee, chaired by #1 recipient of largess, Jim Seward. You really owe it to yourself to look at the whole thing. But, if you can't, at least check out the press release here
Here is what I think the money quote is, as to the report:
"Our report suggests that health insurance company campaign contributions explain why rate
regulation and other important health insurance consumer protections are not passing the
Legislature," said Scharff. "We are tired of wondering what matters more, the donors or the voters.
New York State must follow in the footsteps of Connecticut and pass Clean Elections, a voluntary
system of full public financing."
...and then, here is what to do about it:
In 2008, the Assembly passed A.11507, which would create a strong public funding system that would
give candidates four public dollars for every dollar raised in contributions of $250 or less from New
York State residents. Democratic Minority Leader Malcolm Smith of Queens has introduced a full
public funding bill in the State Senate (S.7175A) with 17 co-sponsors. The bill is modeled on a law
passed by Connecticut in 2005 that the New York Times called "an instant model for other
statehouses."
Malcolm's comin' out here to the country for BBQ this Sunday, so, you know he is gonna be hearing about it from me.... me, and fellow Clean Elections fan, Don Barber, no doubt.
Attorney General Andrew M. Cuomo today announced that he is conducting an industry-wide investigation into a scheme by health insurers to defraud consumers by manipulating reimbursement rates. At the center of the scheme is Ingenix, Inc., the nation's largest provider of healthcare billing information, which serves as a conduit for rigged data to the largest insurers in the country.
Cuomo also announced that he has issued 16 subpoenas to the nation's largest health insurance companies including Aetna (NYSE: AET), CIGNA (NYSE: CI), and Empire BlueCross BlueShield (NYSE: WLP), and that he intends to file suit against Ingenix, Inc, its parent UnitedHealth Group (NYSE: UNH), and three additional subsidiaries.
The six-month investigation found that Ingenix operates a defective and manipulated database that most major health insurance companies use to set reimbursement rates for out-of-network medical expenses. Further, the investigation found that two subsidiaries of United (the "United insurers") dramatically under-reimbursed their members for out-of-network medical expenses by using data provided by Ingenix.
Under the United insurers' health plans, members pay a higher premium for the right to use out-of-network doctors. In exchange, the insurers promise to cover up to 80% of either the doctor's full bill or of the "reasonable and customary" rate depending upon which is cheaper.
The Attorney General's investigation found that by distorting the "reasonable and customary" rate, the United insurers were able to keep their reimbursements artificially low and force patients to absorb a higher share of the costs.
This is huge and very important. It's also very coincidental for a situation with my family. My mother was admitted to the hospital a few months ago for an issue with her stomach. She ended up getting a bill from Blue Cross & Blue Shield that didn't add up. My father, being a former insurance man himself, smelled a rat. He has submitted the information to, among other agencies, the AG's office. Sounds like it's in good hands. REAL good hands.
"I believe it involves a fraud in the hundreds of millions of dollars and affects thousands and thousands of families," Cuomo said. "That's what this investigation is about today." He said the practice and what he called conflicts of interest have gone on for nearly a decade.
"We will continue to cooperate fully," stated UnitedHealth Group in a statement about Cuomo's investigation.
Cuomo's investigation focused on the "reasonable and customary" rate that UnitedHealth used, but which investigators claim was kept artificially low, resulting in profit for the company and unnecessary cost for consumers.
"When insurers like United create convoluted and dishonest systems for determining the rate of reimbursement, real people get stuck with excessive bills and are less likely to seek the care they need," Cuomo said.
His investigators claim UnitedHealth manipulated data and even lied that its reimbursement rates were based on national research.
This is good news. Health insurance companies are a part of the problem, not the solution. Practices like this must stop.
After President Bush vetoed every SCHIP bill that reached his desk and Congress couldn't override those vetoes (or reach an agreement on any sort of SCHIP bill), Governor Eliot Spitzer has taken matters into his own hands.
The budget provides funding to expand the State's version of SCHIP, Child Health Plus, by increasing income eligibility levels from 250 percent to 400 percent of the Federal Poverty Level, making New York's program one of the most comprehensive in the nation. Governor Spitzer made this announcement during his State of the State address and full details of the plan will be outlined in Governor Spitzer's Executive Budget Presentation on Tuesday, January 22, 2008.
"In the face of Washington's inaction, New York State is taking bold steps to ensure the protection and welfare of society's most vulnerable residents: our children," said Governor Spitzer. "President Bush's incomprehensible decision to veto SCHIP has left the duty of insuring children to our state. New York will not allow the failure of the White House to deprive essential health care to those who need it most. This initiative has wide, bipartisan support across the state and I commend all of our partners who have worked tirelessly on behalf of New York's children."
Sen. Hillary Clinton had this response when learning of Gov. Spitzer's plans:
Senator Hillary Rodham Clinton said: "I was proud to support the bipartisan legislation in Congress that would have assisted NY with expansion of Child Health Plus, but the President vetoed it leaving New York and our children on their own. Governor Spitzer's commitment to fully fund the program despite the President's actions will allow tens of thousands of uninsured children to access affordable, quality healthcare and I commend Governor Spitzer for his leadership on behalf of New York's children."
Amen to that. This was an important move. If Bush and his Republican pals won't give us the money, Gov. Spitzer will find the funding for it. Good work.
I just read about this and my jaw dropped. While it's not surprising for politicians to find loopholes and ways around everything, this certainly takes the cake.
By leaving office last week, O'Connor seems to have found a way to maintain free, lifetime health insurance from the county. Such benefits were owed to him under a 1998 resolution that provided lawmakers with more than 20 years of service with full coverage free of charge. In June, those eligibility guidelines were altered so that any lawmaker with O'Connor's years of experience would have to pay 50 percent of their premiums if they were sworn in Jan. 1. By resigning when he did, O'Connor becomes immediately eligible for free coverage, while retaining his ability to return to office next year.
Niagara County Attorney Claude Jeorg said he fully expects O'Connor to return to office and said, legally, there's nothing that would prevent him from doing so. He added that there may be some questions about O'Connor's health insurance eligibility, some of which may be answered by the county's insurance department and others that may require court action to sort out.
The availabilty and affordability of decent health insurance is the major domestic scandal/issue.
But some people who can afford insurance get it for free, because they are political hacks who are connected to part-time appointed jobs that, unlike all part-time (and most full-time) jobs in the private sector, provide free comprehensive health insurance.
Some people like Alfonse D'Amato, a former three-term Republican U.S. senator who now is a multi-millionaire influence peddler.
Newsday has a front-page story today on the latest example of D'Amato's corruption.
