Ending insurance discrimination, closing coverage gaps proving difficult in reform efforts

Current health reform efforts seek to prevent insurers from rejecting individuals or charging people higher rates based on their medical history. However, a simple ban would not take away the economic pressure that encourages such practices, The Washington Post reports: "Cognizant of the threat, lawmakers are trying to neutralize it. For example, the bill advanced by Senate Finance Committee Chairman Max Baucus (D-Mont.) calls for creation of complex mechanisms to essentially raise or lower compensation to insurers, depending on whether they attract disproportionately sick or healthy populations. The bill assumes the problem would be greatest during the first few years; after that, part of the machinery to compensate for variations would go away."

"A straightforward way to reduce gamesmanship is to standardize benefit packages, [Paul Precht, director of policy at the Medicare Rights Center] wrote in a July report. One issue lawmakers must resolve is how much latitude to leave insurers over what they cover and how. ... Unless lawmakers tackle the problem effectively, a reformed health-care system could continue to reward insurers for avoiding rather than treating illness. It also could perpetuate existing economic penalties for health plans that do a better job of covering the sickest patients. They tend to attract costlier members, which can force them to raise premiums, fueling a cycle that can make it harder for the severely ill to get affordable coverage" (Hilzenrath, 10/4).

Meanwhile, USA Today reports on efforts to address gender gaps in coverage: "Women's health groups, legal organizations and some female senators are fighting for a host of little-known provisions in the health care legislation being debated in Congress that they say will dramatically improve health care and insurance coverage for women. From a ban on insurance companies charging women more for the same policies as men to a requirement that companies provide maternity coverage as part of their basic plans, advocates say the provisions would correct longstanding inequities and offer more coverage to women at lower costs."

Sen. Jon Kyl, R-Az., and other GOP members "say basic policies shouldn't be required to include coverage for things that not everyone will use." Although the "ongoing fight in Congress over whether government-funded insurance should cover abortions has generated most of the headlines" regarding women's health issues, advocates say "issues such as maternity coverage and fair pricing affect far more women, who have received inadequate care and coverage for too long" (Hall, 10/4).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.