health care overhaul Insurers dissuade sick from enrolling in plans

Associated Press

Insurers no longer can reject customers with expensive medical conditions, thanks to the health care overhaul. But consumer advocates warn that companies still are using wiggle room to discourage the sickest — and costliest — patients from enrolling.

Some insurers are excluding well-known cancer centers from the list of providers they cover under a plan; requiring patients to make large, initial payments for HIV medications; or delaying participation in public insurance exchanges created by the overhaul.

Advocates and industry insiders say these practices may dissuade the neediest from signing up and make it likelier that the customers these insurers do serve will be healthier — and less expensive.

“It’s the same insurance companies that are up to the same strategies: Take in as much premium as possible and pay out as little as possible,” said Jerry Flanagan, an attorney with the advocacy group Consumer Watchdog.

Insurers acknowledge that people may see changes in coverage, driven in part by how the overhaul affects insurance. But they say prudent business practices, not discrimination against the sick, are key factors behind some of the trends that have raised concerns.

They point out that if customers find a plan they don’t like, they generally have plenty of additional options to choose from both on and off the exchanges.

They also note that the overhaul takes several steps to discourage them from avoiding costly patients.

It prevents insurers from marketing or designing a plan that would discourage someone from applying based on his or her health.

It also calls for insurers to chip into a pool that compensates competitors who wind up with a more-expensive patient population.

That lowers their incentive for discouraging the sick from enrolling.

“Health plans now guarantee coverage for individuals and families regardless of health status,” said Clare Krusing, a spokeswoman for the trade association America’s Health Insurance Plans, or AHIP.