health care reform

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Think you don’t need health care reform if you’re covered by your employer? Wrong.

Tuesday, February 16th, 2010

You may have heard that Anthem-Blue Cross proposed raising its rates for individual health insurance policies by as much as 39 percent in California. President Obama and Secretary of Health and Human Services Kathleen Sebelius have both decried this outrageous hike. A recent report from the Associated Press shows that similarly huge rate hikes are coming to individual policies in many states including Maine, Kansas, Oregon and Indiana.

“You’re going to see rate increases of 20, 25, 30 percent” for individual health policies in the near term, Sandy Praeger, chairwoman of the health insurance and managed care committee for the National Association of Insurance Commissioners, predicted Friday.

But you might think that this has nothing to do with you if you’re employed by a company that provides you with health insurance. Unfortunately, all of us are affected, no matter where we get our insurance.

The Anthem-Blue Cross increase is the harbinger of things to come in employer-provided policies as well.

Last week, I heard from someone whose employer had to switch from a comprehensive policy to bare bones insurance because the insurer raised the company’s group rate by about 30 percent. So now, instead of offering employees a policy that covers just about anything, from a broken ankle to a liver transplant, the company will offer its employees a policy with an annual cap of just $25,000.

That’s employer-provided insurance that’s in danger now. And that means that more Americans are at risk of having either no insurance or inadequate insurance when a medical emergency strikes.

As a doctor, I am well aware of the high cost of medical care and can assure you that a policy with a $25,000 annual cap won’t cover much if you need hospitalization. I’ve dealt with that reality, not just as a physician, but as a mother. As I wrote on this blog before, when my daughter had to be hospitalized a few years ago, we learned too late that her school-provided policy had a $25,000 annual cap. Lucky for Kimmie that her parents are both doctors and could afford to pay the tens of thousands of dollars in hospital and medical bills that her insurance didn’t cover.

What would you do if one of your loved ones needed medical care and your insurance was inadequate?

This is no longer an issue for the uninsured. It’s an issue for us all. Please tell your Senators and Congressional representatives that you support health care reform. The life of someone you know, maybe someone you love, maybe your own, may depend on what happens next in Washington, DC.

- Yvonne S. Thornton, MD, MPH

Why Health Care Reform Is Essential to You and Your Family – Even if You’re Insured

Thursday, January 28th, 2010

Last night, President Obama, in his State of the Union address, reminded us why we need real health care reform.

First, I’ll quote a few of the points the president made and then I’ll explain why it matters to each of us, currently insured or not:

“The approach we’ve taken would protect every American from the worst practices of the insurance industry. It would give small businesses and uninsured Americans a chance to choose an affordable health care plan in a competitive market.  It would require every insurance plan to cover preventive care.

“… It would reduce costs and premiums for millions of families and businesses. And according to the Congressional Budget Office – the independent organization that both parties have cited as the official scorekeeper for Congress – our approach would bring down the deficit by as much as $1 trillion over the next two decades.”

When the president spoke of the insurance companies “worst practices” he didn’t elaborate. But it’s those practices that make us all, insured or not, vulnerable, and in need of reform. Too many Americans believe that they have great health insurance – right up to the moment when they get sick and find that their insurance won’t cover their medical bills.

Recently, one of the organizations advocating on behalf of health care reform shared the case histories of numerous people who, although insured, were unable to get their medical bills paid when they got sick. The following few cases are among dozens of similar stories. If we don’t think it can happen to you, you’re wrong. I speak from experience. Although I’m a doctor, when my daughter became ill, her insurance refused to cover all her medical costs and I had to pay tens of thousands out of pocket.

  • An AT&T worker from Arkansas was in a coma for three weeks after a 2004 horseback riding accident. She and her husband had to pay more than $200,000 in medical bills because UnitedHealthcare wouldn’t cover her emergency surgery.
  • A Realtor from Delaware, has a health care plan that forces her to pay for her cancer care “out of pocket.” She has turned to getting her chemotherapy medication from India in order to afford it.
  • A minister from Tennessee has almost $175,000 in medical debt due to his wife’s muscular disorder. The family had health insurance through his wife’s job as an insurance claims adjuster, but the health insurance would only cover 14 days of her 91 days in intensive care.

Don’t let anyone tell you that if you’re insured, you don’t need to support health care reform. As the above cases illustrate, this affects us all. While there is no longer any chance of passing a new bill through the United States Senate, the House can vote for the Senate bill that passed over Christmas eve now and make changes over time.  It may be our last chance for reform in a generation. Please call your Congressperson today and remind him or her what’s at stake.

- Yvonne S. Thornton, MD, MPH

The best Christmas present the Senate could give us: Health care for all

Thursday, December 24th, 2009

Despite months of bluster and disinformation from those who hope to maintain the status quo, 60 U.S. senators came together this Christmas Eve morning and voted to make health care available to virtually all Americans.

The House had passed its version of health care reform months earlier. Now the two legislative bodies will have to come together and agree to a blended version.

That blended version almost certainly won’t have a public option because it would require 60 votes in the senate to get one. But here’s what we can be assured of getting in any final combination of the two bills:

  • Insurance companies will have to cover everyone – you can no longer be turned down due to pre-existing conditions.
  • Insurance can’t be snatched away from you via “rescission” when you get sick, i.e., voiding the policy when you need it the most.
  • There will be limits on how much more insurers can charge you as you get older.
  • Your insurance won’t run out when you need it due to annual or lifetime caps.
  • Most lower and middle-income people will get subsidies to help pay for insurance.

For those who say the senate bill doesn’t do enough, remember that getting this passed was a Herculean task. This is just the start of reform. Over the years, our lawmakers can continue to improve the bill, just as they’ve done with Social Security and Medicare. This is a long overdue beginning to regulating the health insurance companies, which have been given carte blanche for so many years.

The Centers for Disease Control recently reported that 58.4 million Americans were uninsured for at least part of the year and almost 32 million had been uninsured for more than a year. The situation will only get worse if we do nothing. As President Obama is fond of saying, we can’t let the perfect be the enemy of the good. This is a good bill. And it’s the best present that the U.S. Senate could give us this holiday season.

Merry Christmas to all.

- Yvonne S. Thornton, MD, MPH

Halfway to realizing real health care reform

Wednesday, November 11th, 2009

This past weekend, in the House of Representatives, our congressmen and congresswomen came together to pass a bi-partisan bill. In doing so, they took the first step toward ensuring that all Americans have access to health care when they need it.

If a final bill passes that includes the provisions of this bill, here’s what we can all look forward to:

* No more lifetime or annual caps on how much treatment health insurance will pay for. This is so very important for men, women and children with chronic illnesses, who often see their claims for care denied, just when they need it most.

* No more denial of insurance coverage for pre-existing conditions. As of right now, some health insurers consider having had a cesarean section a “pre-existing condition.” They deny claims to victims of domestic violence, calling it a “pre-existing condition.” Even perfectly healthy babies who are a bit chubby have been turned down by health insurers who claim their weight is a “pre-existing condition.”

* Adult children would be allowed to remain on their parents’ policies until age 27.

* Seniors on Medicare would pay less for prescriptions.

* And all would get a genuine choice of health insurance options, available from both health insurance companies and a government-administered plan (the public option).

None of us should have any illusions that this first step toward making health care affordable and available to all will make the next steps any easier. Powerful interests, particularly those of health insurance companies, will fight all that much more aggressively to prevent the senate from passing its own version of reform. Health insurers’ profits are as high as they are because they get to cherry-pick who they will and won’t cover; because they can refuse to provide care after someone has reached the annual or lifetime coverage cap; because they can call almost anything a “pre-existing condition.”

Through misinformation campaigns, spread by surrogates, these powerful special interests have done all they can to frighten Americans into believing that health care reform will be bad for them and for America. The misinformation often mirrors that which was spread back in the 1960s in an attempt to prevent Congress from passing Medicare.

As a physician who has seen, firsthand, how the lack of health insurance can devastate families, I know that we must fight back aggressively against the special interests. We must become informed about the realities of health care reform and help our friends and families understand the difference between information and misinformation.

This opportunity to provide health care for all may not come again for many years if it doesn’t succeed now. And if it fails today, next time, the fight will be even harder and will stand less chance of success.

As a doctor, a woman, and a mother, I urge our senators, no matter their party affiliation, to stand with our families and help us protect them when they are most vulnerable. And I urge my readers to contact their senators and tell them that nothing is more precious than health – and nothing more important than passing reform so that families can get the help they need when they need it.

- Yvonne S. Thornton, MD, MPH

Is baby fat a “pre-existing condition? Really?

Tuesday, October 13th, 2009

You may have read the news that a family in Colorado was told their 4-month-old son would be denied health insurance by Rocky Mountain Health Plans because of a pre-existing condition: he was too chubby.

The child in question, baby Alex Lange, weighs just 17 lbs and is 25 inches long. That puts him in the 99th percentile according to the CDC but his pediatrician says the baby is perfectly healthy.

Although the insurance company’s spokesperson, Dr. Douglas Speedie, agreed that a baby can be healthy at little Alex’s weight, he said that the line has to be drawn somewhere. “It’s a calculation based on height, weight, and a fudge factor.”  But he also said “We’d like to see health care reform so that these things go away.”

Just think of that for a minute. Why does a health insurer claim there is a pre-existing condition where none exists? And if an insurer acknowledges that this is a flawed decision-making process, why doesn’t it act on its own to make “these things go away”? Does this make sense to you?

Me neither.

And that illustrates why we need health care reform. Right now, insurers can claim people have “pre-existing conditions” that they don’t actually have, and make other arbitrary decisions to deny people care. That must change and insurance companies will not change on their own … well, except in cases where their decisions are so ridiculous that they make the nightly news.

In baby Alex Lange’s case, the negative publicity convinced the insurer to reverse its decision. But the reason that Alex’s story got so much attention is that his daddy works for the NBC TV affiliate in Colorado that broke the story.

Most other people just get stuck with the insurance company’s arbitrary decisions.

- Yvonne S. Thornton, MD, MPH

White House lists the benefits of proposed health care reforms

Friday, August 14th, 2009

I’m glad the government has spelled out what Americans can expect from a health care reform bill. Here’s what the White House says will be in the final bill:

  • No Discrimination for Pre-Existing Conditions
  • Insurance companies will be prohibited from refusing you coverage because of your medical history.
  • No Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays
  • Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.
  • No Cost-Sharing for Preventive Care
  • Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.
  • No Dropping of Coverage for Seriously Ill
  • Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.
  • No Gender Discrimination
  • Insurance companies will be prohibited from charging you more because of your gender.
  • No Annual or Lifetime Caps on Coverage
  • Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.
  • Extended Coverage for Young Adults
  • Children would continue to be eligible for family coverage through the age of 26.
  • Guaranteed Insurance Renewal
  • Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won’t be allowed to refuse renewal because someone became sick.

And here is a link to answers to Frequently Asked Questions that I hope will dispel fears and refute the misinformation.

- Yvonne S. Thornton, MD, MPH