While the insurance companies and Obama bitch at each other, another deal appears to have been made by the industry, Senate Finance chair Max Baucus, and the administration. This one will be just too much for people who have not been able to decide whether to be for or against the weak reforms shaping up in Congress.
It goes like this: For many people desperate for medical treatments previously denied by private insurers, the reform bills in Congress offer litttle hope. As it stands, policy holders have great difficulty in reversing an insurance company’s denial of treatment–for example, an MRI which the insurance company doesn’t think is necessary or a new cancer treatment that costs a lot. Micahel Moore’s Sicko was full of stories about this, including some from survivors of patients who had died after their treatments were turned down by insurers. Apparently, none of that will change if the reform legislation is passed.
The Employee Retirement Income and Security Act (ERISA), reports Kaiser Health News, “bars suits for damages over health benefit decisions” for the 132 million people who get insurance through employers. The health care bills currently making their way through Congress, which are at least supposed to address the worst excesses of the insurance industry, do nothing to remove the barrier.
The Los Angeles Times reports:
… a patient’s ability to fight insurers’ coverage decisions could be more important than ever because Congress, in promoting cost containment and price competition, may actually add to the pressure on insurers to deny requests for treatment.” The bills would require insurers to “cover everyone, regardless of pre-existing conditions,” making it “more difficult for insurers to control their costs, or ‘bend the cost curve,’ by avoiding sick people. That leaves insurers with the other big cost-containment tool: turning down requests to cover treatments.
Experts said the legislation under consideration does not significantly enhance patient protections against insurers refusing to cover requests for treatment. Most people currently have no right to challenge health insurers’ treatment decisions by suing them for damages.