Remy Ceci has been healthy for 19 years, but has not been able to find health insurance during that time.
Ceci, 58, was diagnosed with gastric lymphoma 20 years ago. It was successfully treated with surgery and chemotherapy, but because Wisconsin is one of only eight states that allows insurers to look back for an indefinite time at consumers' medical history when deciding whether to provide health insurance -- most states limit the "look-back" period to six months or a year -- insurers have refused to cover her.
"I would be glad to pay for insurance if I could get it," said Ceci, who runs a specialty coffee business in Pepin. "I can't get it. I'm uninsurable."
Ceci's story is one of many that makes Wisconsin, "one of the worst states in protecting people with pre-existing conditions," according to Robert Kraig of Citizen Action of Wisconsin.
"Wisconsin gets a failing grade in allowing insurance companies not to cover pre-exiting conditions such as cancer or heart disease or other conditions people need insurance for in the first place," he said.
The study released today by health care watchdog Families USA surveyed insurance commissioners in all 50 states and the District of Columbia, covering such issues as "cherry-picking," discriminatory charges, refusal of coverage for medically prescribed care, revocation of insurance when a consumer contracts a serious illness and state limits on the use of insurance premiums for non-medical expenses, such as advertising.
Wisconsin scored zilch in 10 of 14 categories listed in the report.
In a conference call hosted by Citizen Action Wisconsin, which released the report in Wisconsin, two state Democratic legislators, Sen. Kathleen Vinehout, D-Alma, and Rep. Jon Richards, D-Milwaukee, along with U.S. Rep. Steve Kagen, D-Wis., said health insurers need to be reigned in. "We cannot fix a national crisis going state-by-state because the insurance industry is able to hide behind state lines," Kagen said. "And state insurance commissioners, however powerful they may be, are no match for the power of the insurance industry."
In February, Kagen, a physician, introduced legislation that would make it illegal for insurers to deny insurance for pre-existing conditions. That legislation has not yet had a committee hearing. "I am framing health care as a constitutional issue," he said. "We have constitutional rights that protect us from discrimination."
His proposal would also regulate insurance policy charges by region, restoring community-based ratings that regulated insurance premiums decades ago. He also called for a national standard for insurance policies by which all insurance companies would have to abide.
But Vinehout, vice chair of the Senate Committee on Health, Human Services, Insurance, and Job Creation, said that reform has to begin with the state. "Given the problems we have in getting that national movement off the ground, I believe we have an obligation to begin at the state level," she said.
Vinehout is a key backer of the Senate Democrats' $15 billion "Healthy Wisconsin" proposal, which would provide universal health insurance under a state-run system. The proposal passed the Senate but died after the Republican-led Assembly refused to consider it. "The way to deal with this is to have one large risk pool," she said. "And the larger the risk pool, the lower the risk, and the lower the cost." She said the Healthy Wisconsin plan would address the state's major health care shortcomings.
"The problems that we're facing at the Capitol here in Madison is we don't have the political will to address the problems," she said. "Addressing the problems means addressing the insurance industry. It means putting regulations on the insurance industry that are not now there."
Richards said that health care consumers here are "worse off than people in other states," because they face the double whammy of costs that are rising faster than the national average and insurers who are largely unregulated.
"We have robust law in this state that protects people when they're buying a car or getting a repair on their house, and that's the way it should be," he said. "In Wisconsin the health care consumers are actually second-class citizens when it comes to looking at our protections under the law right now. It's clear that other states have found a way to do a much better job protecting consumers and Wisconsin has to start going down that road."
Asked for comment on the Families USA report, Phil Dougherty, Senior Executive Officer of the Wisconsin Association of Health Plans, said he hadn't reviewed the document. State Insurance Commissioner Sean Dilweg was unavailable for comment.
The report also found that Wisconsin came up short by:
Not requiring insurers to sell insurance to all applicants.
Not prohibiting higher premiums based on health status.
Not reviewing premium hikes before they go into effect.
Not requiring insurers to limit non-health-care spending, such as marketing, to 25 percent of premiums.
Not limiting the length of time insurers can exclude people because of pre-existing conditions.
Not having standards for defining what a pre-existing condition is, leaving the insurers to make the call.
Not requiring underwriting to be completed during the application process, allowing insurers to change conditions of policies at will.
Not reviewing revocation of coverage.
Not offering free review of denial of claims.
In three categories -- accepting appeals upon revocation of coverage, reviewing denials of insurance claims, and making review decisions binding -- the state received a passing score.
The state scored partial credit on another category, requiring alternative coverage for uninsurable patients.
Steven Elbow — 6/12/2008 2:32 pm
http://www.madison.com/tct/news/291176
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