"Most Americans today get health coverage through group plans offered by employers. When workers receive insurance through their jobs, an insurer cannot exclude them from coverage, or charge more, because of a preexisting condition.
But for increasing numbers of Americans who are losing their jobs and their group coverage - or who never had it to begin with - a primary option is to buy insurance as an individual or family on the open market.
In 44 states, including Pennsylvania, insurers are allowed to deny coverage - or charge more - to individuals and families because of preexisting conditions, according to the Kaiser Family Foundation.
Without insurance, these sick Americans too often go without needed care, or go into debt paying out of pocket. A report by the Institute of Medicine confirmed this week that the uninsured get sicker and die sooner.
The exclusion 'is in some ways the ugliest corner of our current system,' said Len Nichols, director of the Health Policy Program at the New America Foundation."
For lack of a dentist, a boy dies Deamonte, died at the age of 12, Prince Georges County, Maryland: Deamonte, a seventh grader in Prince George’s County, Maryland, just outside of Washington, D.C., died because he didn’t have health insurance to cover an $80 tooth extraction. The inexcusable loss of this 12-year-old’s life started when he complained of a toothache. His mother, Alyce, who works at low-paying jobs, didn’t have employer health insurance, and had been focused on finding a dentist to see Deamonte’s brother, who had six rotting teeth. Their Medicaid insurance coverage had been cut off, and Alyce’s efforts to renew the coverage were ensnarled in red tape and bureaucratic delays. Here is Devante's tragic story. Devante, died at the age of 14, Houston, Texas:
Devante was a 13-year-old boy with advanced cancer of the kidneys who went without any health coverage for four months while his mother attempted to renew his Medicaid coverage. Although his mother, Tamika, submitted at least three renewal applications beginning in February 2006—one through the financial counselor at Texas Children's Hospital—and called the CHIP/Medicaid hotline dozens of times, there was no record of Devante's case in the system when advocates contacted the call center on his behalf in August 2006. Because of a state staffing shortage, officials say his application went unprocessed. Meanwhile, Devante went without any health insurance and had to depend on clinical trials for care as his tumors continued to grow.
Health protection yanked: Jessica Bath claims Blue Shield scoured for reasons to drop her and her son because he needed costly care; the firm says mom left out medical issue on application Four months after her first son, Jack, was born, Jessica Bath received a letter from her health insurance company, Blue Shield of California, saying she and Jack were no longer covered. Jack was born at Sierra Vista Regional Medical Center on April 8, 2003, with a hole in his heart. Bath was counting on Blue Shield to pay for a scheduled surgery to repair it.
Suddenly, both she and Jack were uninsured. "It was absolutely devastating for us," Bath said. "How were we going to pay for his heart surgery?"
WORK HARD, AND SAY WHAT, PLAY BY THE RULES? To understand the challenges of insuring the health of the nation’s work force, consider Varney’s Book Store.A Portrait of the Working Insured After a long bout with emphysema an employee at Varney’s, a family-owned business in Manhattan, Kan., died several years ago. But for Varney’s health insurer, her legacy lived on. The next year, 2002, the insurer raised Varney’s premiums by 28 percent — even though most of the other three dozen employees were significantly younger and healthier than their departed colleague, who had been in her mid-70’s. And Varney’s premiums continued to climb. . . .Such are the challenges for smaller businesses in Kansas and the many other states where laws permit insurers to raise health premiums substantially for small employers when one worker incurs significant medical bills. And it is why, as state legislatures, Congress and presidential candidates of all stripes debate the growing problem of Americans without health insurance, the struggles of small businesses — which employ about 40 percent of the nation’s work force — are likely to become a central issue. Small-business employees are one of the fastest-growing segments of the nation’s 44 million uninsured; they now represent at least 20 percent of the total, according to federal census data. And even modest-size employers like Varney’s that say they remain committed to providing benefits find themselves wondering how long they can continue. Plights of uninsured stir efforts to sway lawmakers WASHINGTON — Tamika Scott lost her 14-year-old son to cancer on March 1, less than a year after he lost his health insurance and was forced to go on clinical trials. Within a month of his death, Scott was in the nation's capital telling her story to members of Congress. It was too late to help her son, Devante Johnson, but not the nation's 47 million uninsured, including 9 million children. "When it touches home, everything changes," says Scott, 34, of Houston. "Then you're ready to change the world." As Congress and state legislatures grapple this year with how to help the uninsured, lawmakers are increasingly hearing not only from lobbyists and health care advocates but from people who have suffered without insurance. They are people like Alyce Driver of Maryland, whose 12-year-old son Deamonte died in February from an infection that spread from his tooth to his brain. People like Camilla Tecsy of New York, also 12, who lost health insurance for several months while battling cystic fibrosis. People like Mekeal Cusic of Mississippi, who couldn't get coverage for her 10-year-old daughter Keyonna because of intestinal problems suffered three years ago. All have been to Washington this spring to personalize an otherwise complex financial issue. "There are heart-wrenching stories that really do rip your heart out," says Sen. Tom Carper, D-Del.
Can This Patient Be Saved? As a surgeon, I’ve seen some pretty large tumors. I’ve excised fist-size thyroid cancers from people’s necks and abdominal masses bigger than your head. When I do, this is what almost invariably happens: the anesthesiologist puts the patient to sleep, the nurse unsnaps the gown, everyone takes a sharp breath, and someone blurts out, "How could someone let that thing get so huge?" I try to describe how slowly and imperceptibly it grew. But staring at the beast it has become, no one buys the explanation. Even the patients are mystified. One day they looked in the mirror, they’ll say, and the mass seemed to have ballooned overnight. It hadn’t, of course. Usually, it’s been growing — and, worse, sometimes spreading — for years. . . .It’s as true of societies as of individuals. We did not muster the will to reform our long-broken banking system, for example, until it actually collapsed in the Great Depression. This is, in a nutshell, the trouble with our health care crisis. Our health care system has eroded badly, but it has not collapsed. So we do nothing.
AARP seems to be interested more in selling junk insurance than acting on behalf of the seniors it purports to lobby for.
UnitedHealth Group and AARP will announce today that they have agreed to extend and broaden contracts that enable the health insurer to sell Medicare products under the powerful AARP brand.
The announcement of a 7-year extension to their marketing agreement puts to rest speculation that UnitedHealth's stock-option scandal would endanger the deal and that AARP would find a new partner. The current 10-year contract expires at the end of the year.
AARP, a lobbying and interest group representing millions of U.S. citizens over 50, is one of UnitedHealth's most significant customers and provides an enormous sales vehicle into the aging population.
The new agreements, which take effect Jan. 1, provide UnitedHealth with a pipeline to AARP's nearly 38 million members.
"The fact that it is being continued is a positive unto itself," said Thomas Carroll, an analyst with Stifel Nicolaus in Baltimore.
In 1998, UnitedHealth signed a 10-year deal with AARP to offer certain products to AARP members; in 2005, the relationship was expanded to include an exclusive partnership to market drug plans under Medicare's prescription drug program, called Part D.
Last year, analysts began speculating about whether a renewed contract with AARP would be threatened after errors in UnitedHealth's stock-option granting practices came to light. At an investor's conference in New York in December, analysts questioned company officials. Worries were that AARP would view the link with
UnitedHealth as troublesome. AARP Contracts With Aetna, UnitedHealthcare To Expand Available Health Insurance Policies To People Ages 50 To 64, Quality-of-Care To Be MeasuredAARP officials on Monday announced plans to expand the number of health insurance products offered by the group that will target U.S. residents ages 50 to 64 who lack coverage, the Wall Street Journal reports (Fuhrmans, Wall Street Journal, 4/17). As part of the expansion, AARP in 2008 will begin to market with Aetna a PPO for U.S. residents ages 50 to 64, as well as a high-deductible health plan possibly linked with a health savings account. AARP said that underwriting practices for the health plans for such residents -- who "often find that health insurance is unavailable or unaffordable" in the individual coverage market -- will "be less stringent than those of many commercial insurers," although the plans will deny coverage to some sick residents, according to the New York Times (Pear, New York Times, 4/17).
AARP initially will market the health plans in about half of the states. In addition, AARP in January 2008 will begin to market with UnitedHealth Group a Medicare Advantage plan. Medicare beneficiaries who enroll in the plan will have no monthly premiums but will have to make copayments for physician visits and prescription drugs. AARP initially will market the plan in about half of the states (Appleby/Wolf, USA Today, 4/17). The plan is "guaranteed to be in the Medicare marketplace for two years," although premiums and copays could change after the first year, Dawn Sweeney, CEO of AARP Services, said. AARP also will continue to offer Medigap plans (New York Times, 4/17). The new plans likely will double the number of residents who receive health insurance through AARP and UnitedHealth by 2014, according to Sweeney (Phelps, Minneapolis Star Tribune, 4/17). AARP CEO William Novelli said, "In launching these initiatives, we are driven by our mission to create a healthier America" (New York Times, 4/17).
Back in 2003 when AARP got on the Medicare Part D bandwagon, Physicians for a National Health Program pretty much laid out the AARP plan: The American Association of Retired Persons (AARP) derives significant income from the sale of health and life insurance policies, and stands to make hundreds of millions more under the Medicare Prescription Drug bill now being debated before Congress. Yet the AARPís financial interests in the bill have received scant attention.
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We believe the AARPs huge insurance business helps explain why it has endorsed a bill that threatens the future of Medicare and the health of Americaís seniors. Under the proposed Medicare legislation the AARP would almost surely reap hundreds of millions of dollars in additional insurance revenues over the next decade. The Medicare bill would pump $400 billion in Federal Government money into new Medigap drug policies over the next decade. At present, the AARPís profit from its huge insurance sales amounts to 3.9% of the insurance premiums it collects. If AARPís partners were to capture even 10% of the new Medicare prescription drug coverage market, their premiums would amount $40 billion, and the AARPs profits would be $1.56 billion. The Medicare prescription drug bill offers huge payoffs to the drug industry, private insurers, and some large employers. It would provide paltry benefits to Medicare recipients and take a giant step toward privatizing Medicare. In effect, the AARP leadership has shamefully agreed to sell out its members in exchange for the organizationís financial gain.
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