'Underinsured' Face Financial And Coverage Problems

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Health care is increasingly expensive, including for the insured, and many insurance plans offer only limited benefits and a false sense of security.

The New York Times reports that "an estimated three-quarters of people who are pushed into personal bankruptcy by medical problems actually had insurance when they got sick or were injured. And so, even as Washington tries to cover the tens of millions of Americans without medical insurance, many health policy experts say simply giving everyone an insurance card will not be enough to fix what is wrong with the system. Too many other people already have coverage so meager that a medical crisis means financial calamity."

The Times reports: "In the House and Senate, lawmakers are grappling with the details of legislation that would set minimum standards for insurance coverage and place caps on out-of-pocket expenses. And fear of the high price tag could prompt lawmakers to settle for less than comprehensive coverage for some Americans. But patient advocates argue it is crucial for the final legislation to guarantee a base level of coverage.... [and] call for a new layer of federal rules to correct the current state-by-state regulatory patchwork that allows some insurance companies to sell relatively worthless policies." The Times notes: "If everyone in the country were required to have insurance, the industry says - a mandate that Congress is contemplating - the costs and risks of insurance would be spread over a large enough pool of people to let insurers provide full, affordable coverage even to people with pre-existing medical conditions. ... Senator John D. Rockefeller IV, Democrat of West Virginia, who is also on the Finance Committee, has introduced legislation that would require insurers to be more clear about what they do - and do not - cover. He says he advocates such a change, even if Congress cannot agree to a more sweeping overhaul of the health insurance industry" (Abelson, 6/30).

Meanwhile, the Los Angeles Times reports on a lawsuit that found insurers were acting illegally when it comes to autism: "State regulators are violating mental health and other laws by allowing health insurers to deny effective treatment for children with autism, consumer advocates contend. In a lawsuit, Consumer Watchdog, a Santa Monica group that monitors insurance practices, is asking a judge to order the Department of Managed Health Care to require insurers to provide autistic members with the services their physicians have ordered." The Los Angeles Times notes: "Insurers have long declined to pay for a variety of behavior-modification therapies, such as applied behavior analysis, because of the expense -- as much as $70,000 a year per child. More than 37,000 children with the most severe cases receive services, such as applied behavior analysis, through the state. Because the state's limited budget for such children is rationed according to the neediest, thousands more suffer debilitating problems but are ineligible for state aid" (Girion, 7/1).

This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.org.

© Henry J. Kaiser Family Foundation. All rights reserved.