Docs Back Insur­ance Reforms

Can we make health coverage more transparent?

Texans' health insurance premiums continue to rise while coverage has stagnated or decreased, says Dr. Josie Williams, president of the Texas Medical Associa­tion. Consumers are "paying more and more and receiving less and less, and they really don't understand their health insurance policies," she said during a March 25 press conference at the Capitol.

As such, the TMA, the nation's largest doctors' group, is joining forces with a handful of lawmakers to support reforms that would make health coverage more transparent. Among reforms it's backing are a pair of companion bills filed by Sen. Wendy Davis, D-Fort Worth (Senate Bill 1611), and Rep. Todd Smith, R-Euless (House Bill 1748), that would prohibit insurers from finding arbitrary reasons to dump clients. In one case, Smith said, a Northeast Texas woman had her insurance canceled after she was diagnosed with breast cancer and was in need of a mastectomy. Her insurer told her she had failed to note on her coverage application that she'd once been treated for acne. The practice, known as "rescission," allows insurers to cancel policies when they believe a consumer has lied or hidden information about a health condition or previous treatment – regardless of whether it relates to a condition that is currently being treated. "It is an unethical practice that [encourages] abuse," Davis said, "so they can get out of paying for expensive treatments."

As the TMA's Williams sees it, the insurers say they're trying to ferret out fraud, but the practice has become problematic – especially in California. And if the problem has yet to take hold in Texas, Williams said it's just a matter of time until it does, because the same insurance companies implicated in the practice there also operate here. Smith said his bill would allow canceled consumers to appeal to a third party for review, "as a matter of basic fairness."

Other health insurance reforms backed by the TMA include the so-called Soup Can Label Bill (SB 815, by Sen. Kirk Watson, D-Austin, and HB 1932, by Rep. Senfronia Thompson, D-Houston), which would require insurers to market their products in a standard format that would allow "apples to apples" comparison, and the Health Insurance Code of Conduct Act (SB 1257, by Sen. Kip Averitt, R-Waco, and HB 2750, by Rep. Craig Eiland, D-Galveston), which would prevent companies from arbitrarily raising insurance rates and require them to receive outside input before canceling the coverage of seriously ill or injured patients.

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KEYWORDS FOR THIS STORY

health insurance reform, Texas Medical Association, Josie Williams, rescission, 81st Legislature, Todd Smith, Wendy Davis, SB 1611, HB 1748

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