Wednesday, November 11, 2009

House bill would ban domestic violence as pre-existing condition

One little-noticed, though important, provision in the House-passed version of health reform (HR 3962) would prevent health insurers from treating domestic violence as a pre-existing condition. Currently, eight states (Idaho, Mississippi, North Carolina, North Dakota, Oklahoma, South Carolina, South Dakota, and Wyoming) and the District of Columbia allow insurers to reject men and women who’ve been victims of spousal abuse for coverage.

The House bill would ban the practice for both employer-provided, group health coverage and for the individual health insurance market. A similar provision exists in the Senate Committee on Health, Education, Labor and Pensions health reform bill.

Apparently, or so the thinking goes, if a person has survived spousal abuse, he or she is more likely to be beaten again and thus, is more expensive to insure. According to one commentator, “in human terms, it’s a second punishment for a victim of domestic violence.” It’s not that no one has tried before this to ban the practice; there have been a number of attempts at the federal level, but so far, these efforts have been unsuccessful.

Apparently, state law bans haven’t been enough to totally outlaw the practice. According to one commentator, “even in those states that have passed legislation prohibiting the practice, insurance companies are said to often initially reject past victims seeking insurance in the individual market.” According to Kaiser Health News, “it’s unclear how often such rejections [due to domestic violence] take place. But it is clear, experts say, that the fact that they occur at all can have a chilling effect on victims, who may be afraid to tell their doctors about attacks out of concern they'll have trouble getting insurance in the future.”

How soon could relief arrive for domestic violence abuse victims? Under the House bill, the provision barring domestic violence as a pre-existing condition would apply to group health plans, and health insurance issuers offering group health insurance coverage, for plan years beginning on or after January 1, 2010. The provision also would apply to health insurance coverage offered, sold, issued, renewed, in effect, or operated in the individual market on or after that date.

In a September speech, First Lady Michelle Obama said that using domestic violence as a preexisting condition is among the insurance practices that "still wake me up at night." This is one provision, at least, that can’t come soon enough.


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