The Patient Protection and Affordable Care Act made the practice of denying coverage for preexisting conditions illegal as soon as the Department of Health and Human Services begins to phase in the law. But until that happens, there’s public opinion to be won and lost.
Having caught wind from a Reuters article that one Indiana-based insurer is not just denying but revoking coverage from women with breast cancer, the Obama administration decided to make an example out of someone and hit back at the company, called WellPoint, with a strongly worded letter from HHS Secretary Kathleen Sebelius. Here’s an excerpt:
"As you know, the practice described in this article will soon be illegal. The Affordable Care Act specifically prohibits insurance companies from rescinding policies, except in cases of fraud or intentional misrepresentation of material fact.
"WellPoint should not wait to end the unconscionable practice of deliberately working to deny health insurance coverage to women diagnosed with breast cancer. I urge you to immediately cease these practices and abandon your efforts to rescind health insurance coverage from patients who need it most."
It’s hard to argue with Sebelius’s jab—and that’s exactly what makes it unfair. WellPoint, which has 33.7 million policyholders, fits in the administration’s narrative of evil, greedy insurers who care more about profits than about providing good coverage. After all, who could possible slam the door in the face of women with breast cancer? Only a selfish insurance-selling slime ball, of course. But that ignores two things. One is that WellPoint—and any insurer, really—is a company, not a benevolent nonprofit or NGO. The other is that, frankly, denying coverage isn’t entirely illegal yet, which makes it rather unfair to fire at a company for acting to its advantage while it still can. (Of course the aversion to such practices is what sold reform as a moral imperative in the first place.)
But the bigger problem here is that potential loopholes could still make denial of coverage possible under the new law, mostly because the new system lacks the regulatory reach to crack down on all offenders. It’s a big deal if the health-care-reform law falls short on one of its signature promises. But if that’s the case, perhaps the law either needs to be improved or the regulators need more resources to implement it effectively. Short of that, it’ll take a lot more than a few bluntly worded letters to make sure the practice finally ends.
UPDATE: WellPoint responds with a letter from CEO Angela Braly saying that the Reuters piece "grossly misrepresent[s] WellPoints efforts to help prevent, detect and treat the 1 in 8 of our 34 million members nationwide affected by breast cancer." She also asked for a personal meeting with Sebelius.