FLORIDA HEALTH INSURANCE

September 21, 2007

End of Pre-Existing Conditions

Medical insurance policy-holders can now rejoice. Insurance companies are reviewing claims settlement norms in case of preexisting diseases. This means, insurers may soon no longer deprive mediclaim holders for claims under the clause of “non-disclosure of diseases”.

Accordingly, policyholders who never underwent treatment nor showed symptoms of a disease before signing a policy document are likely to get the medical policy benefits in future.

At present, insurance companies often decline to settle insurance claims in case policyholders are diagnosed to have contracted the disease prior to the signing the mediclaim policy.

This is likely to change. The General Insurance Council of India, in consultation with all insurers, is working on the appropriate definition of preexisting diseases.

“Policyholders who did not undergo any diagnosis or treatment or show indications of a disease prior to the signing of a contract should not be considered in the know of having any preexisting disease,” said Mr BD Banerjee, a member of the committee, appointed by Insurance Regulatory and Development Authority (Irda) for examining issues related to health insurance for senior citizens.

He was talking to reporters on the sidelines of an interactive session on health insurance, organised by Bengal Chamber of Commerce and Industry here on Saturday. The seven-member committee is likely to submit its report by the first week of November. It is slated to meet in Mumbai from October 9 to 11.

The insurance regulator was formed by the committee in May this year in the wake of a over 200% hike in premium for medical insurance policies after September 2006. The insurers increased the premium for senior citizens defying the regulator’s advice not to hike it more than 70%.

Mr Banerjee felt “most private insurers turn down health policies to people aged above 60. Among the public sector insurers, only Oriental Insurance as of now does not offer health insurance policies to senior citizens. It has, however, applied for a policy for senior citizens to Irda.

Issues relating to health insurance for the elderly need special focus, as they are more vulnerable and fall in a higher risk category.

Fixing Our Broken Down Health Care System

Every Democratic and Republican presidential hopeful has come up with a health care plan for the nation. Some blueprints are more ambitious than others, but there is a collective acknowledgment that America's health care system is ailing.

The conversation to fix it, which began during the administration of Franklin D. Roosevelt, took a serious turn during the Clinton administration 14 years ago. It was ultimately dragged down by fear-mongering over a highly complicated plan conceived in secrecy by then-first lady Hillary Rodham Clinton.

Mrs. Clinton is now running for president, and her health care plan is more comprehensible than the earlier version, although it still has holes regarding universal coverage and realistic financing.

For several years after the Hillarycare debacle, most politicians were reluctant to lead on health care, even as the need for a better system grew.

Twenty years ago, 29.5 million Americans under the age of 65 had no health insurance. Today, that number is 44.8 million, surely a blot on the nation. Most of the uninsured live in working families and do not qualify for government help through Medicaid.

The number of uninsured is expected to continue rising. Moreover, the quality of care has deteriorated. Waiting times to see physicians has grown. Try making an appointment with a neurologist or urologist a month ahead.

Adversity creates opportunity for change, however. Pollsters tell us a majority of Americans favor guaranteed health care. Powerful interest groups from business, labor, hospitals and even insurers are calling for action. Automobile manufacturers are asking for a bigger government role in ensuring universal coverage.

The presidential candidates are responding because constituents are asking for, and in many cases demanding, remedies.

It's not enough to run for or against the trillion-dollar war in Iraq, deal with Iran and make peace between Arabs and Israelis. Even those who have health care protection are uncertain about the future of their health care.

The federal government is failing to rise to the challenge. We have the most expensive health care system in the world, but Medicare's budget is under strain and Medicaid is in perpetual crisis. The government borrows money to keep both programs solvent.

Election 2008

The Democrats:

Sen. Hillary Rodham Clinton's is the latest of the health care proposals unveiled by the Democratic candidates. She estimates its cost at $110 billion. Like Former Sen. John Edwards, she would demand that every American have health insurance. She would ask that employers either cover their workers directly or pay for their costs under one of the other options of her plan. To soften the requirement for smaller businesses, she would offer a tax credit for coverage. Individuals could enroll in private insurance programs patterned on the options given to federal employees or join a new public insurance program modeled on Medicare.

Edwards has called for a similar insurance mandate for employers along with a coverage mandate for individuals. Although he maintains that his plan would ease the costs of covering employees, he does not call for the same tax credit mechanism for small business. His option for coverage include new "health care markets" -- large purchasing pools that would allow businesses and individuals to take advantage of economies of scale in obtaining coverage. He estimates that his plan would cost between $90 billion and $120 billion.

In addition to private insurers, the new health care markets would include a public coverage option modeled on Medicare. Over time, if enough individuals and employers end up opting for the Medicare clone, it could evolve into something resembling the single-payer system in place in many other countries.

None of the Democrats, however, with the exception of Rep. Dennis Kucinich, is proposing a near-term overall shift to a single-payer system.

Like Edwards and Clinton, Sen. Barack Obama, of Illinois, would mandate employer contributions for the cost of health care. He would require coverage for all children but not for adults, although he argues that the cost savings he'd promote at the same time would have the effect of moving the country to universal coverage. In a feature common to the Democratic plans, he would demand that insurers be barred from refusing or terminating coverage because of medical history. Obama would create a so-called national insurance exchange designed to make it easier for consumers to shop among private plans, along with a public option modeled on choices available to federal workers. Obama has projected his plan's cost at between $50 billion and $65 billion.

The Republicans

Former Massachusetts Gov. Mitt Romney is the Republican most identified with health care reform. As governor, he was one of the architects of an innovative Massachusetts program that mandates coverage while creating a "connector" to provide information about private plans along with a state sponsored program for basic coverage. The plan has attracted national attention. Romney, however, does not want to use it as a model for the nation. Rather, he has called for the 50 states to be the incubators of health care reforms with a general reliance on the private market. He has encouraged the health savings accounts favored by the Bush administration. He would use tax breaks to make it easier for individuals to purchase insurance and would shift Medicaid funding to states to a block grant to allow more latitude for experimentation.

In contrast to the Massachusetts model, he would not mandate coverage for individuals. And in common with his GOP rivals, he does not hold out universal coverage as a near-term priority for national health care policy.

Giuliani similarly heralds the private market as the best bet to deliver better coverage and cost control. He would provide a tax deduction for individuals purchasing health insurance along with tax credit for lower income Americans to obtain coverage. He would offer block grants to states to promote innovation in coverage solutions, including issues such as the difficulty in obtaining coverage for individuals with prior medical conditions. Giuliani, who was once treated for prostate cancer, contends that the private market is the most reliable promoter of the kind of high quality health care he received. He has denounced various Democratic proposals as recipes for "socialized medicine."

Former Tennessee senator Fred Thompson, relatively new to the race, warns against bigger government solutions to health care, but has offered few specifics as yet on what initiatives he might promote.

"Those who propose a one-size-fits-all Washington-controlled program ignore the cost, inefficiency, and inadequate care that such a system offers," he says in a statement on his Web site. "Access to affordable, portable health care can be made available for all Americans without imposing new mandates or raising taxes."

Sen. John McCain of Arizona, focused chiefly on national security, hasn't offered any detailed proposals on health care in the course of the campaign.

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