FTCR welcomed the draft rules' reaffirmation of the existing legal standard that policy "rescissions" -- retroactive cancellations of coverage -- can legally be carried out only if patients "willfully misrepresented" their health condition when applying for coverage. But FTCR said that such a standard will not protect patients unless an impartial regulator is in charge of deciding whether a proposed cancellation is legal.
Additionally, FTCR said the draft rules are problematic because:
-- Even relief through litigation may be too little, too late. The person whose health coverage has been cancelled is left uninsured and their health put in jeopardy while awaiting legal review.
-- Insurers are allowed to retain investment income they earned off premiums paid on cancelled policies. By retaining investment income, insurers profit directly from illegal rescissions as well as preventing further payouts. Since 2002, the six largest DMHC -- regulated health plans have earned $1.6 billion in investment income on premium payments.
Weak Cancellation Rules Add to Problems With Mandatory Purchase Law
Affordability and enforcement problems with the mandatory purchase of private health insurance, as backed by Gov. Schwarzenegger, are compounded by weak cancellation rules. Under the proposed law, patients whose coverage was improperly rescinded would be required to buy substandard care at a higher price.
"It is absurd that the Governor would even consider requiring patients
to buy private health insurance policies at a time when insurers are
allowed to flout the law and cancel policies when patients need coverage
the most," said Jerry Flanagan of FTCR. "A mandatory purchase regime
amounts only to a customer delivery system to an industry whose MO is to
put profits before patient
|SOURCE Foundation for Taxpayer and Consumer Rights|
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