AS ANNIE MAYS-MAHOOD can testify, it's hell to not have affordable health insurance. She nearly lost everything after her husband David hit his head in a car accident in the late '80s and started having chronic, violent seizures. For a couple of years she had to pay his medical expenses out of her own pocket while confusion about whether he could get Social Security benefits was resolved. Since she had also quit her job to take care of him, her finances soon got so bad that she briefly had to rely on welfare to keep from losing her home.
Mays-Mahood, who is plagued by recurrent kidney stones, still can't afford insurance for herself. Even if she had the cash, it's not clear where she could buy it as an individual. In September, the three major carriers, Premera Blue Cross, Regence Blue Shield, and Group Health, closed their individual programs to new patients, heightening the health insurance crisis. In all but one Washington county it is no longer possible to buy regular individual health insurance policies. (Insurance Commissioner Deborah Senn responded to this crisis by opening the state's high-risk insurance pool to all comers, but the cost is prohibitive.)
In Olympia, Washington's legislators are under the gun to do something to bring individual insurance back. It looks like their solution, Senate Bill 6067, will take the sickest patients out of the general insurance pool and segregate them into high-risk plans, which are more expensive. The bill is actually a leftover from last year, when it passed the Senate with the governor's support but didn't pass the full Legislature.
Health care activists say it's a direct attack on the reforms the Legislature passed a decade ago to protect all insured patients from industry discrimination. It's also, they say, an attack on the woman who pushed for those reforms, Insurance Commissioner Deborah Senn.
The bill's sponsor, Senator Alex Deccio, R-Yakima, says that the reforms of the '90s simply didn't work. He partly blames Senn, who he says sought to build a political base by antagonizing the insurance companies. In fact, Senn's actions pissed off Deccio so much that he sponsored an unsuccessful bill to make the insurance commissioner an appointed, rather than an elected, position. Deccio says the only way to keep coverage affordable is to encourage healthy people to pay into comprehensive plans for years before they get sick and relieve them of the burden of paying for those who are already ill.
But worried activists argue the bill offers more relief to insurance executives than to consumers. American Cancer Society lobbyist David Allen says some of the bill's provisions "stick it to the consumer" needlessly. Foremost in activists' minds is the requirement that new enrollees wait nine months to get treatment for preexisting conditions. The only exceptions will be for enrollees who've lost their previous coverage through no fault of their own, i.e., their carrier canceled their plan or their doctor left that plan. The new waiting period will apply to everyone else, including workers enrolling in group coverage through their employers. Activists see this as another attack on the consumer protections forged a decade ago, one of which imposed a maximum of three months for waiting periods, the shortest in the country. Allen says that "for cancer patients, waiting six months is a death sentence," let alone waiting nine.
Deccio counters that the waiting period must be lengthened because patients have abused it. It's no accident, he says, that the proposed new waiting time is the length of a woman's pregnancy. He believes pregnant women and other people with new health concerns jump to an expensive plan and then leave when the baby is born or the health problem goes away. Regence's Callie Denton insists that such behavior is keeping premiums high for consumers who stay in the more expensive plan. But Allen asserts that carriers have brought it on themselves by restricting some commonly used benefits to just one overburdened and expensive plan. He doesn't understand how carriers could offer women plans that don't include maternity care and not expect them to switch when they get pregnant. In fact, the bill may be penalizing patients for a crime they haven't even committed; Jim Stevenson with the insurance commissioner's office points out there's only anecdotal evidence that people do switch plans according to their immediate needs.
ANOTHER PROVISION in Deccio's bill gives carriers the go-ahead to make new enrollees fill out a questionnaire that will ask the applicant about his or her health history and, possibly, that of his or her family's. The questionnaire will identify the 8 percent of patients it would probably be most expensive for carriers to cover. These patients would be turned over to the state's high-risk pool, which essentially is a state-run plan that all carriers must offer. The pool is now unpopular with sick patients; though it provides more benefits than the average plan, it's also more expensive. Not only would the Senate bill force the sickest of these people into the pool, it would also make it even pricier for most, although enrollees under 200 percent of the poverty level would be subsidized by the state.
Activists say this provision erases one key reform of the 1990s, which was to spread the costs of insurance among everyone so it would be affordable to sick and healthy folks alike. Allen warns that this part of the bill will only push health care costs for seriously ill patients, such as those living with cancer or AIDS, onto the federal government or hospitals, because coverage for these people will become so high they'll have to go on Medicaid or not take coverage at all. And activist Barbara Flye of Washington Citizen Action says the questionnaire will make it easier for carriers to discriminate against all enrollees. "Even if you're not screened out [into the pool] they'll have that information," she says.
Democratic legislators who might be inclined to agree with activists appear to be caught between a lingering terminal disease and a long, painful death. Representative Eileen Cody, D-Seattle, introduced a bill that would have lengthened the waiting period to only six months while providing greater subsidies for people in the high-risk pool. The bill made no mention of a questionnaire. Carriers refused to support it, activists say largely because the companies already had Deccio's bill in the Senate. The bill is now dead, and Cody says she might introduce compromise legislation. Allen says that Cody's bill wasn't perfect but points to "the direction we should be going." He worries, though, that any further compromise will spell defeat for Washington's patients. The session is more than half over, and at this point Dems have little choice but to go along with the Senate bill. As Regence's Denton points out, "Resolution of this crisis can't wait."
Read more about Insurance Commissioner Deborah Senn.