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Sick People: No Invitation to the Party

The major health insurers held a hot-ticket event yesterday – first United Healthcare announced that it would retain key patient protections and health coverage guarantees, no matter how the Supreme Court rules on the Affordable Care Act, and by mid-afternoon it seemed like all of the other health plans wanted to be at the party, too.  

First, United Healthcare kicked off the festivities in grand style by promising that it would continue to cover preventive care without requiring patients to make copayments, allow young adults to stay on their parents’ health plans as dependents through age 26, and continue to follow the new law’s ban on lifetime benefit limits. United will also continue to enforce patient rights through a streamlined appeals process and will not seek to rescind a member’s coverage after they become sick (except in cases of a fraudulent insurance application).

Other insurance plans wanted to join the party. As the day wore on, Humana and Aetna announced that they would continue to honor identical or near-identical reforms, with Aetna emphasizing that they would also continue working with hospitals, doctors and other health providers to develop innovative delivery system reforms – another hallmark of the new law. The national Blue Cross Blue Shield Association “encouraged” local Blues plans to continue to honor these provisions from the ACA.

Other plans, such as CIGNA and Wellpoint, weren’t sure that they wanted to join the festivities. But most importantly, one type of guest wasn’t invited to the party at all. Namely, sick people. Without the health care law, people with pre-existing conditions – whether they are children with a genetic condition or a severe childhood illness, women who have previously delivered a child via Caesarean section or survived domestic violence and received treatment related to this abuse, or the one out of two American adults who live with a chronic disease – cannot be certain that they will able to purchase health insurance in the individual market.

These health insurers should be applauded for their willingness to continue some of the early insurance reforms of the Affordable Care Act, whether or not they are required to do so. But their inability to promise that sick people can buy insurance just points out, more than ever, why we need the health care law in the first place.

Health plans can’t promise to sell policies to sick people – or at least, they can’t promise to do so unless all of their competitors promise to sell to sick people, too. Otherwise, the plan that offers this guarantee will be the plan with all the sick and expensive enrollees, and the costly premiums that healthy people won’t want to pay. The sad truth – which brings down everyone’s party mood – is that health plans won’t cover sick people unless they are required to by the law. That’s why millions of Americans still need this most-important part of the ACA to remain in place.

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