Health reform bills may not protect consumers from treatment denials

"Despite growing frustration with the way health insurers deny medical treatments, major healthcare bills pending in Congress would give patients little new power to challenge those sometimes life-and-death decisions," The Los Angeles Times reports. "Yet a patient's ability to fight insurers' coverage decisions could be more important than ever because Congress, in promoting cost containment and price competition, may actually add to the pressure on insurers to deny requests for treatment." The bills would require insurers to "cover everyone, regardless of pre-existing conditions," making it "more difficult for insurers to control their costs, or 'bend the cost curve,' by avoiding sick people. That leaves insurers with the other big cost-containment tool: turning down requests to cover treatments."

"Experts said the legislation under consideration does not significantly enhance patient protections against insurers refusing to cover requests for treatment. Most people currently have no right to challenge health insurers' treatment decisions by suing them for damages." The Employee Retirement Income and Security Act (ERISA) "bars suits for damages over health benefit decisions" for the 132 million people who get insurance through employers. Current health care bills do not remove the barrier (Girion, 10/19).

In a personal finance column, The Los Angeles Times takes a look on how health care reform in general could affect consumers: "While some of the details are not yet decided (and may not be fully decided for months), a picture is emerging that could help you better understand how buying health insurance could change under the proposals," including changes in access, new mandates to carry health insurance and new requirements for the kind of coverage insurers provide (Kristof, 10/18).

In a Q&A, The Los Angeles Times also reports on how the antitrust exemption for health insurers affects consumers (Geiger and Oliphant, 10/19).

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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.