Oh, What a Week It's Been

As expected, this week saw a lot of activity in the Senate Finance Committee. Although the Committee voted down two different versions of a public option, they passed sort of a mini-public option, proposed by Sen. Maria Cantwell, that would provide government-run insurance to people who do not qualify for Medicaid whose income is under 200% of the federal poverty level (or about $20,000). In addition, the Committee voted to limit health insurance executive salaries to $500,000 per year. About 2 million people were exempted from the requirement to purchase insurance if doing so would create a financial hardship, and the penalty for those who fail to do so have been decreased dramatically, to $200 in 2014. Financial hardship would be found to exist if insurance costs more than 8 percent of income. In addition, discounts would be offered to people who quit smoking or lose weight (and, by the way, my diet is going well -- slow, but steady -- 8 pounds so far).

The Finance Committee finished its mark-up at 2:15 am this morning. The Congressional Budget Office will "score" the bill, reporting back on how much it will cost. Then the full Committee will vote next week. Once that happens, the Finance Committee bill and the Senate HELP Committee bill will be merged into one and debate on the Senate floor will begin. The Columbus Day recess has been canceled, so debate is expected to begin during the week of October 12.

Not soon enough for me!

I have gotten more really big new files in the last few days than I have in a very long time. I keep getting calls from people whose insurer has decided not to cover a medication when the medication is being prescribed for a use other than the one for which it is FDA approved. These are called "off-label" uses. As a matter of law, the FDA labeling governs marketing of medication, not prescribing or insurance coverage. Although the FDA itself encourages doctors to try off-label uses, recognizing that this often is the only way to learn what uses may be found for a drug, insurance companies increasingly are using the fact that a drug is being prescribed off-label as an excuse to avoid payment.

I've also been getting a lot of calls from people who've already exhausted all of their appeal rights, so they really have no option but to give up or sue. Suing health insurance companies is very difficult; in general, insurance companies are presumed to have been rational and reasonable. In addition, in most cases, it's less expensive to pay for the drug than it is to sue an insurance company.

And then there's the woman who was scheduled for a double mastectomy for breast cancer whose insurance was canceled four days before the surgery was scheduled to occur.

And the lupus patient whose insurance was entirely revised, excluding coverage of her lupus because it was a pre-existing condition when, in fact, the patient had minimal symptoms before purchasing her insurance -- so minimal that she'd never even mentioned them to a doctor.

Then there's the health insurance plan that has denied a treatment as "experimental," but which refuses to provide the patient with the plan's definition of "experimental" -- a clear violation of law.

Are the insurance companies campaigning to see just how outrageous they can be right when Congress is debating health insurance reform? Because that's surely how it looks to me. They seem to be increasing the pressure on people just when these sorts of stories are making them the targets of health insurance reform. In a sense, I suppose the more outrageous they are, the stronger the case for health insurance reform. Still, these stories break my heart.

I wish the members of Congress who are opposed to strong reform measures would sit in my chair for one day. Jennifer