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Wisconsin Fails Health Insurance Protections

Insurers can deny coverage and hurt consumers

Jun. 18, 2008
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Conservatives’ solution to the health care crisis is to provide tax credits to allow individuals to buy their health insurance in a competitive marketplace. But in Wisconsin, as in many other states, the individual health insurance market does little to protect the consumers it is supposed to serve.

According to a new report from Families USA, insurers in Wisconsin:

  • Are not required to sell coverage to all consumers who apply
  • Can charge some consumers higher premiums based on their health status
  • Can spend less than 75% of their premiums on health care, and instead use that money for administrative costs, high salaries, advertising and profits
  • Have no limits as to how far back they can exclude coverage for an individual based on pre-existing conditions such as cancer or heart disease
  • Have no limits on how far back they can look into an individual’s health history to decide which conditions will not be covered
  • Are not bound by an objective standard definition of “pre-existing condition”
  • Can deny or limit coverage of a health condition after an individual has become covered by the policy
Not surprisingly, Wisconsin has one of the worst individual health insurance consumer protections in the country— especially for those who have pre-existing conditions.

Families USA reported that protecting individual consumers has been the responsibility of the states, but the insurance lobby has pushed for an unregulated market in which insurers can cherrypick the healthiest consumers. “This leaves consumers with a patchwork of protections that are inadequate as a whole and that vary greatly from state to state,” the report noted.

Discrimination, Pure and Simple
High-profile Republicans such as presidential nominee John McCain and Wisconsin Congressman Paul Ryan have advocated for a more free-market approach to health insurance, which would allow consumers to use tax credits to shop around for health insurance.

These consumers would not be provided with insurance through their employers. But Robert Kraig of Citizen Action of Wisconsin, who organized a discussion about the Families USA report, said that this type of reform would hurt consumers instead of empowering them. “Due to very weak consumer protections, individuals have very little bargaining power and are vulnerable to a series of abusive insurance company practices,” Kraig said.

Wisconsin Democratic Congressman Steve Kagan, a physician, said that these abusive practices are discriminatory, pure and simple. “We have constitutional rights that protect us from discrimination—until you get sick,” Kagan said. “If you get sick, the insurance industry has the opportunity to discriminate against you based on a pre-existing condition. As I read the United States Constitution, it guarantees that no one will be discriminated against based on the color of one’s skin. What about the chemistry of one’s skin?”

What’s your take? Write: editor@shepex.com or comment on this story online at www.expressmilwaukee.com.


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