One of the most destructive practices of private health insurance companies is the practice of denying care to customers for frivolous reasons. Earlier this year, the Department of Health and Human Services started including denial rates on its information section about health insurance companies on HealthCare.gov, in an effort to inform the public about this practice by the industry.
It was this practice of frivolous denials that ended up costing Jacksonville, Florida woman Alisa Wilson her life. For months, Wilson, her family, and the surrounding community had been pleading with her HMO to approve coverage for a liver transplant. Although Wilson was enrolled in the state’s Medicaid program, she was not guaranteed care because she was “forced to join a private plan as part of a Gov. Jeb Bush-era experimental overhaul of the program,” meaning she had to deal with a private, for-profit insurance company to get her care, not a government agency accountable to the public.
Bush’s overhaul made “Florida the first state to allow private companies, not the state, to decide the scope and extent of services to the elderly, the disabled and the poor, half of them children,” the New York Times reported in 2005, as the move was being considered. “[N]o one is proposing changes as far-reaching and fundamental as” Bush, the Times noted.
After “scores of e-mails and…the help of a Florida state legislator,” the HMO, Sunshine State Health, finally gave in and approved coverage for Wilson two weeks ago. Yet her health was too severe for surgery by then. On Friday evening, Wilson passed away:
Alisa Wilson, 37, died Friday at 8:50 p.m. after a lengthy battle with an undisclosed liver disease, said her father, Eric Wilson. “Her liver was gone,” Wilson said. “There was no more left. She needed that transplant two weeks ago.”
About a week and a half ago, attorneys working on Wilson’s behalf said the insurance obstacles had been worked out. By then, however, her health was too shaky to risk going under the knife. “If they did it months ago, my daughter would be alive now,” her father said.
Representatives for Sunshine State and the Florida Agency for Health Care Administration, which manages Florida’s Medicaid program, said they couldn’t speak to the specifics of the case, citing privacy laws.
Unfortunately, it has become increasingly common for states to outsource their Medicaid programs to be administered by private health insurance companies that have little accountability to the public compared to public programs like Medicare. A 2010 Kaiser Family Foundation report found that “All states except Alaska and Wyoming have some portion of their Medicaid population enrolled in managed care” — where Medicaid pays out to private organizations like Managed Care Organizations that contract with HMO’s — and “managed care is the dominant care delivery system in most state Medicaid programs. Forty-six states and DC have more than half their enrollees in managed care; in 20 of these states, over 80% of the Medicaid population is enrolled in some form of managed care.”
While the recently passed health care law is doing much to curb some of the worst abuses of the health insurance industry, one of the best ways to help people avoid these practices of the private health insurers is to offer them an alternative like a Medicare-style public health insurance option. As a part of her deficit reduction plan, Rep. Jan Schawkowsky (D-IL) proposed a robust public health insurance plan that would be offered to Americans. Not only would it operate cheaper and not committ the same abuses as the private insurance industry, it could cut the deficit by as much as $10 billion during its first year of implementation alone.