Copyright 2009 San Jose Mercury NewsAll Rights Reserved San Jose Mercury News (California)
October 31, 2009 Saturday
LENGTH: 1337 words
HEADLINE: For those denied insurance because of preexisting conditions, health reform would bring major change
BYLINE: By Mike Zapler [email protected]
WASHINGTON Kelsey Jessup, 26, is a model of healthful living. The Palo Alto native runs five days a week, practices yoga and stays away from red meat. But none of that mattered when Jessup recently applied for health insurance. Because she had knee surgery to repair a high school soccer injury and went to the emergency room after fainting a few years ago, she was denied coverage by multiple insurers.
Ronald Sturm, 62, of San Jose is diabetic but has managed his condition for five years with regular insulin shots and by eating right. Otherwise he's in good shape, he says, pointing to his part-time job as a referee running up and down high school gymnasiums. But Sturm, too, can't get coverage; he pays out of pocket for doctor visits and medications and prays nothing major happens to him before he qualifies for Medicare at age 65."If I have a serious illness or get hit by a softball and have to go the ER," he said, "I'm in trouble."
The fear of going without health insurance and the frustration of not being able to do anything about it because of a preexisting condition is shared by millions of Americans who have tried unsuccessfully to buy insurance on their own or worry about someday having to do so.With rising unemployment and fast-rising health care costs eroding the security of employer-provided medical benefits, those concerns are fueling Congress' push for sweeping new regulations of private health insurers.
While much of the health care debate has focused on whether or not to create a so-called public option, or government-run health plan, the most fundamental change that Congress is considering may be its move to outlaw insurers' policy of seeking the healthiest patients and weeding out those most likely to need medical care, a practice known as medical underwriting."For people buying insurance on their own, it would be a completely different" experience, said Gary Claxton, a vice president at the Kaiser Family Foundation, a nonprofit health care research foundation. "They'd have a menu of good benefits to shop for and buy, and insurers couldn't turn you down for a preexisting condition. That just doesn't happen much now."
Some of the stories about preexisting conditions and health insurance border on the absurd. In one recent case, a 4-month-old boy in Colorado was denied coverage because, at 17 pounds, the insurance company deemed him too fat. The Huffington Post reported this month that a Florida woman was rejected because she took anti-AIDS drugs after being raped, raising questions among insurers about whether she had HIV. And documents uncovered a few years ago by Consumer Watchdog detailed the underwriting practices of some large California insurers, which included automatically denying coverage to anyone with acne, asthma or attention deficit disorder, among other conditions, as well as expectant fathers and construction workers.Short of those extremes are millions of other cases in which people with medical conditions, serious and minor, have found themselves at the mercy of private insurers because they don't have group coverage through a job. Plans provided by large employers do not discriminate against those with preexisting conditions, as their higher health care costs are offset by those of healthier employees.
When the Mercury News recently asked readers to share their experiences with the health care system, time and again they wrote of being denied insurance for reasons beyond their control.Trish Curren, a 32-year-old mother of two from Santa Clara, applied for insurance but was turned away repeatedly because she previously had been diagnosed with gallstone pancreatitis and irritable bowel syndrome. She went uninsured for 18 months but later managed to get coverage from the department store where she works. But the bare-bones plan carries a $4,000 deductible, which she can't afford on her minimum wage salary.