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Massachusetts health care — wonky, with a healthy dose of reality

Health Care Wisdom from the Wall Street Journal

Health Care Wisdom from the Wall Street Journal

June 2, 2005

Their editorial views are not my cup ot tea, but the health journalism produced by the Wall Street Journal is among the best. Here's are samples from four WSJ articles published on Monday, 5/31:

  • "Seeking Insurance, Individuals Face Many Obstacles": While Pres. Bush and others emphasize the "ownership society," it is not clear how expanding the individual insurance market "would help people whose health isn't perfect and who are most in need of help with medical costs." There are "big holes" in the individual market system, and federal protections do little "to protect people" from higher premiums and denial of coverage for pre-existing conditions. While state-run high-risk pools offer some relief for uninsured with high medical costs, these pools have problems such as high premiums and a low enrollment threshold.
  • "Having Insurance Doesn't Guarantee Coverage": A mother attempted to obtain an individual health plan for her baby. After a two-week period of being uninsured, she received coverage through a BlueCross/BlueShield of Arizona plan. Doctors then found the baby needed a $90,000 operation to correct a bone disorder, but BlueCross denied the claim, saying it was for a pre-existing condition and such care was excluded from coverage for 11 months after the plan was purchased. "Buying individual insurance doesn't mean that coverage of medical treatments is guaranteed; [m]uch depends on state rules and a policy's fine print."
  • "Health Insurers New Target": Health insurers including UnitedHealth Group, Aetna and BlueCross and BlueShield plans are realizing that many uninsured residents "are the same relatively healthy Americans they used to cover or administer to in employer health plans" and are targeting them with low-cost health plans. Insurers are marketing "hipster" plans to relatively healthy young adults between 19 and 29; limited-benefit packages to part-time workers, temporary workers and early retirees; and health savings accounts and high deductible insurance to middle class residents.
  • "Coverage Issues: Many Ailments Can Pose Problems": Patients with chronic medical conditions such as HIV, cancer and diabetes might not be able to obtain insurance coverage, but even patients with less severe medical problems can face barriers, according to a study by Georgetown University researchers. Researchers created 7 hypothetical patients with a range of medical problems and applied for coverage at 19 insurers in 8 states. The "patients" applied for 420 plans and were accepted by 266. A hypothetical man with HIV was denied coverage by all insurers, while a man with a knee injury was denied coverage 12% of the time and a 24-year-old woman with seasonal allergies was rejected by 8% of the plans. For knee and allergy patients, health plans often excluded coverage for pre-existing conditions or charged the patients higher premiums.