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Leading National Patient Advocacy Group Commends Insurance Industry's Recognition, Focus on Growing National Problem of Uninsured and Underinsured Americans
Date:12/19/2007

National Patient Advocate Foundation Calls for Stronger National Measures, Urges America's Health Insurance Plan Proposal to Go Further

WASHINGTON, Dec. 19 /PRNewswire-USNewswire/ -- The National Patient Advocate Foundation (NPAF) -- a national, non-profit organization dedicated to creating avenues of patient access to health care through state and federal public policy reform -- supports America's Health Insurance Plans' (AHIP's) acknowledgment today in its Individual Market Guarantee Access Proposal that in order to achieve universal and affordable coverage in the U.S., problems with individual market coverage -- particularly relating to individuals with pre-existing conditions -- need to be addressed first. However, NPAF said that the AHIP proposal does not go far enough to ensure affordable access to health coverage for the sickest Americans.

"NPAF very much welcomes the industry proposal as the recognition that there is a real problem of pre-existing condition coverage to be solved; however, we believe that its characterization of the problems individuals face with rescissions, denials and affordability issues have been significantly underestimated," said Nancy Davenport-Ennis, President and CEO of NPAF. "NPAF has been working on changing the way pre-existing conditions are covered since January 2007, and -- contrary to the AHIP proposal -- believes that significant attention at the federal level will be needed to implement meaningful solutions through Guaranteed Access Plans and third-party review processes for resolving pre-existing condition disputes."

While the AHIP proposal includes broad recommendations for guaranteeing coverage in the individual market through the establishment of state Guarantee Access Plans, implementation of this plan would place significant responsibilities on states that are already experiencing severe financial difficulties covering their uninsured populations and funding their state high-risk pools. Currently, 34 states operate high-risk pools, but only 184,000 patients are enrolled in these pools nationwide. Many states have waiting lists for these high-risk pools since they cannot adequately fund the pools.

Over the course of the past few years, case managers at NPAF's companion organization, the Patient Advocate Foundation (PAF), have seen an increase in patients facing individual coverage problems such as rescissions, disputes involving pre-existing conditions exclusions and other access-related issues. Since the proposal includes a ceiling on how many patients would be guaranteed policies, NPAF believes that the AHIP proposal would in fact cover a limited number of uninsured Americans. Any assumptions made about the proposal covering a larger portion of the 48 million uninsured Americans can only be made by assuming significant legislative action and resource commitment by the states.

NPAF is working with Senator Jay Rockefeller (D-WV), and Representatives Joe Courtney (D-CT) and Allyson Schwartz (D-PA) on legislation (S 2236/HR 2833 and HR 2842) that address barriers to health insurance coverage that individuals with pre-existing conditions face in the healthcare system. With the increased Congressional recognition and involvement on this growing issue, there will be a possibility of a U.S. House of Representatives hearing in early 2008 to focus on health coverage for those with pre-existing conditions.

Additional NPAF concerns about the AHIP proposal include: What pre-existing condition exclusions will look like if an individual applying for coverage in the individual market or under a Guaranteed Access Plan has not maintained continuous coverage; how AHIP defines "continuous coverage;" the timeframe of the application process for a patient waiting on coverage; and what sources are included in the "broad base of sources" that AHIP proposes will fund the Guaranteed Access Plans.

"Any real reform of healthcare, and any hope of attaining universal participation, will occur only if the insurance industry is at the table," said Davenport-Ennis. "While we may disagree with how the industry proposes to leave much of this to the states, we appreciate this first step and look forward to working with AHIP and others to bringing national solutions to these national problems."

National Patient Advocate Foundation (NPAF) is a national, non-profit organization that is dedicated to the mission of creating avenues of patient access through improved access to, and reimbursement for, evolving therapies, therapeutic agents, and devices through policy and legislative reform at the state and federal levels. Our mission is shaped by the experiences of the patients served through our companion organization, Patient Advocate Foundation.


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