Galesburgers for Health Care Reform Regular people working to make a reform a reality…

By David S. Hilzen­rath — Wash­ington Post Staff Writer
Sat­urday, Sep­tember 19, 2009

A pro­posal to make pre­ex­isting health con­di­tions irrel­e­vant in the sale of insur­ance poli­cies could help not just the seri­ously ill but also people who might con­sider them­selves healthy, doc­u­ments released Friday by a California-based advo­cacy group illustrate.

Health insurers have issued guide­lines saying they could deny cov­erage to people suf­fering from such con­di­tions as acne, hem­or­rhoids and bunions.

One big insurer refused to issue indi­vidual poli­cies to police offi­cers and fire­fighters, along with people in other haz­ardous occupations.

Some treated preg­nancy or the inten­tion to adopt as a reason for rejection.

As Con­gress and Pres­i­dent Obama work on leg­is­la­tion to over­haul the nation’s health-care system, one of their main objec­tives is to stop insurers from denying cov­erage on the basis of health status. Pro­posed leg­is­la­tion would pro­hibit insurers from denying cov­erage to indi­vid­uals with pre­ex­isting con­di­tions or charging them higher pre­miums because of their med­ical his­tory — prac­tices known as med­ical underwriting.

Even the insur­ance lobby has endorsed that goal as part of a larger reform package in which the gov­ern­ment would extend cov­erage to the unin­sured, greatly expanding the market for insurance.

Guide­lines that insur­ance com­pa­nies have written for pro­fes­sionals involved in selling poli­cies offer a glimpse inside the under­writing process.

“What these doc­u­ments show is the lengths to which insur­ance com­pa­nies are willing to go to make a profit,” said Jerry Flanagan, health-care policy director of the advo­cacy group Con­sumer Watchdog, which dis­trib­uted the doc­u­ments Friday. “What it shows is that insur­ance com­pa­nies want pre­miums without any risk.”

Con­sumer Watchdog argues that con­sumers should be given the option of enrolling in a government-run health plan. It obtained the doc­u­ments from a Cal­i­fornia insur­ance broker, Flanagan said.

A Paci­fi­Care “Med­ical Under­writing Guide­lines” doc­u­ment from 2003 lists under “Inel­i­gible Occu­pa­tions” such risk-takers as stunt people, test pilots and circus workers — along with police offi­cers, fire­fighters and migrant workers.

Unin­sur­able con­di­tions included preg­nancy, and being an “expec­tant father” was grounds for “auto­matic rejec­tion.” So was having received “therapy/counseling” within six months of the appli­ca­tion. There was also this more gen­eral dis­qual­i­fier: “cur­rently experiencing/experienced within the last 12 months symp­toms for which a physi­cian has not been consulted.”

The Paci­fi­Care doc­u­ment “is com­pletely out­dated and pre­dates the acqui­si­tion of Paci­fi­Care by United Health­care,” Cheryl J. Ran­dolph, a spokes­woman for the parent com­pany, said by e-mail. She declined to pro­vide cur­rent under­writing documents.

“Under­writing enables insurers to ade­quately assess risks, keeping pre­mium costs lower for more con­sumers,” she added.

Health Net guide­lines for 2006 say that people could be denied cov­erage or charged higher pre­miums if they were taking cer­tain med­ica­tions, including Zyrtec, an allergy remedy, and Lamisil, which is widely adver­tised as a treat­ment for toe­nail fungus.

Preg­nant women could be rejected, as could expec­tant fathers, the doc­u­ment said.

A Health Net spokes­woman did not respond to requests to comment.

Blue Cross of Cal­i­fornia guide­lines for 2004 said poten­tial dis­qual­i­fiers included chronic ton­sil­litis and, under cer­tain cir­cum­stances, vari­cose veins.

Kristin E. Binns, a spokes­woman for parent com­pany Well­Point, said by e-mail that she could not com­ment on the guide­lines because they are from years ago.