The Wall Street Journal
The four largest U.S. for-profit health insurers on average denied policies to one out of every seven applicants based on their prior medical history, according to a congressional investigation released Tuesday.
Two top House Democrats said the findings covered 2007 to 2009 for Aetna Inc., Humana Inc., UnitedHealth Group Inc. and WellPoint Inc. In total, the carriers denied coverage to more than 651,000 people due to pre-existing medical conditions over the three-year period.
Under the health-care overhaul legislation, beginning in 2014 insurers can no longer deny coverage because of a pre-existing health condition.
Mohit Ghose, a spokesman for Aetna, said the findings "document what many health insurers, including Aetna, have been saying for years—that the individual market needs to be reformed so we can improve access for all consumers."
Robert Zirkelbach, a spokesman for the insurance trade group America's Health Insurance Plans, said that in the current market, insurers needed to have the option of factoring in health status. That discourages people from buying a policy only after they get sick, which increases costs for all consumers, he said.
Mr. Zirkelbach noted that insurers proposed eliminating denials based on pre-existing health conditions as part of the health overhaul, as long as everyone was required to have coverage.
Henry Waxman (D., Calif.), chairman of the House Energy and Commerce Committee, and Rep. Bart Stupak (D., Mich.) released the findings. Mr. Waxman's office wouldn't specify how many customers each carrier denied.
While most Americans have coverage through their employer or Medicare, an estimated 15.7 million adults under age 65 received coverage through an individual policy as of 2008, the congressional report said. Those are the customers who can be denied coverage because they have a past illness.
In some cases, customers can enroll in a policy but aren't covered for ailments that predate the enrollment. During the three-year period, the four carriers together declined to pay 212,800 medical claims for that reason, the report found.
In a separate report released Tuesday, the lawmakers found that women who are pregnant, fathers-to-be and those attempting to adopt children are generally unable to buy policies on the individual insurance market.
Two top House Democrats said the findings covered 2007 to 2009 for Aetna Inc., Humana Inc., UnitedHealth Group Inc. and WellPoint Inc. In total, the carriers denied coverage to more than 651,000 people due to pre-existing medical conditions over the three-year period.
Under the health-care overhaul legislation, beginning in 2014 insurers can no longer deny coverage because of a pre-existing health condition.
Mohit Ghose, a spokesman for Aetna, said the findings "document what many health insurers, including Aetna, have been saying for years—that the individual market needs to be reformed so we can improve access for all consumers."
Robert Zirkelbach, a spokesman for the insurance trade group America's Health Insurance Plans, said that in the current market, insurers needed to have the option of factoring in health status. That discourages people from buying a policy only after they get sick, which increases costs for all consumers, he said.
Mr. Zirkelbach noted that insurers proposed eliminating denials based on pre-existing health conditions as part of the health overhaul, as long as everyone was required to have coverage.
Henry Waxman (D., Calif.), chairman of the House Energy and Commerce Committee, and Rep. Bart Stupak (D., Mich.) released the findings. Mr. Waxman's office wouldn't specify how many customers each carrier denied.
While most Americans have coverage through their employer or Medicare, an estimated 15.7 million adults under age 65 received coverage through an individual policy as of 2008, the congressional report said. Those are the customers who can be denied coverage because they have a past illness.
In some cases, customers can enroll in a policy but aren't covered for ailments that predate the enrollment. During the three-year period, the four carriers together declined to pay 212,800 medical claims for that reason, the report found.
In a separate report released Tuesday, the lawmakers found that women who are pregnant, fathers-to-be and those attempting to adopt children are generally unable to buy policies on the individual insurance market.
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