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Consumer Reports: 'A World of Pain' For Uninsured Seeking Insurance on Their Own

Posted on: Monday, 3 December 2007, 21:01 CST

YONKERS, N.Y., Dec. 3 /PRNewswire-USNewswire/ -- Consumer Reports' yearlong investigation into health insurance explains the huge hurdles that consumers, including healthy people with minor ailments, face when they try to acquire health insurance on their own.

According to research cited in the report, 89 percent of people who looked into buying individual insurance had not bought it because it was too costly, they were turned down for health reasons, or it provided inadequate benefits. The report, "On their Own," is featured in the January issue of Consumer Reports, on newsstands December 4 and available online at http://www.consumerreports.org/health where CR maintains a health insurance hub for consumers. The report is the third in a series on America's health care crisis.

FIXING THE PRIVATE INSURANCE MARKET: THE HURDLES

"What we've learned in our investigation is that private insurance is virtually out of the question for most uninsured Americans -- 76 percent to be precise -- and those who do manage to acquire insurance on their own tell us wrenching stories about the high costs and poor coverage they receive," said Nancy Metcalf, health editor at Consumer Reports. People in need of private insurance face a daunting dilemma--buying limited health insurance at a high cost or foregoing insurance altogether. Who could fall into this category? Any adult who hopes to retire early, loses a job, is self-employed, or has an adult child leaving a group plan.

CLOSE UP: INDIVIDUAL COVERAGE, MORE COMPLAINTS Source: Consumer Reports National Research Center INDIVIDUAL PLAN EMPLOYER PLAN Overall complaints with coverage 71% 53% Insurance covered most costs 55% 81% Premium is too high 52% 29% Postponed needed medical care because of costs 45% 31% Deductible is too high 41% 28% Does not adequately cover costs of doctor visits 26% 16%

According to Metcalf, the latest nationally representative survey conducted by the Consumer Reports National Research Center underscores the level of discontent of the 7 percent of Americans who manage to obtain individual coverage. "If we're going to rely on individual insurance to fix our health care system, it needs a major overhaul," continued Metcalf.

DISQUALIFYING MEDICAL CONDITIONS

The "world of pain" described in the Consumer Reports investigation hones in on the enormous differences that exist in state regulations of individual insurance plans. A person who could easily buy insurance in one state could be shut out of the market in another. Most striking is the long list of health conditions that could result in being declined coverage, even for such common conditions as hay fever and acid reflux.

Medical underwriting, a practice in which insurers can reject people with illnesses, is the reason why, explains CR. Michael Miano, profiled in the report, learned that he was uninsurable because he had diabetes. Miano's case represents one of the most significant problems in the individual insurance market. While it's illegal for insurers to discriminate against people in group plans because of their health, medical underwriting is allowed in all but a handful of states.

Some prominent examples of medical underwriting: -- Health Net lists diabetes, once diagnosed, as a "declinable condition."

-- PacifiCare may decline anyone who takes prescription medications for high blood pressure, acid reflux, asthma, migraines, arthritis, or depression.

-- Aetna won't insure anyone who's had a hip or knee replacement. FIXING THE SYSTEM: CU's TAKE

Several presidential candidates propose tax incentives for people to buy individual insurance. Consumers Union, the nonprofit publisher of Consumer Reports, opposes that approach because it does nothing to fix the underlying problems, such as medical underwriting, and the tax breaks wouldn't be enough to make insurance affordable for people with lower incomes.

Other candidates propose to expand coverage by bringing more people into the risk pools, by, among other things, requiring insurers to cover everyone regardless of health history, and subsidizing premiums for lower-income consumers. Consumers Union believes that those are more promising approaches, so long as they are coupled with vigorous efforts to control costs, eliminate waste, and encourage better coordination of care for chronic conditions.

TIPS FOR BUYING INDIVIDUAL INSURANCE (Log on to http://www.consumerreports.org/health for more detail)

Know Your State Laws: Log on to http://www.healthinsuranceinfo.net/ for information about state rules outlined by the Georgetown University Health Policy Institute.

Be Careful Leaving a Plan: Consumers should be sure to exercise their rights under the federal Health Insurance Portability and Accountability Act (HIPAA).

Research the Market: Check out http://www.ehealthinsurance.com/, a reputable Web site with links to hundreds of individual plans nationwide. Consumers should also check their state's insurance department Web site, which might have a list of companies licensed to sell insurance.

Get Adequate Benefits: Consumers should make sure that any policy they buy covers everything that is "medically necessary" for any health problem, including emotional disorders.

Look Beyond The Premium: The real costs of an insurance plan include the monthly premium, the annual deductible, and the copays for office visits and prescription drugs.

Keep Looking: Thirty-four states maintain high-risk pools for people who can not pass medical underwriting--though consumers can't count on hearing about that from a broker or private insurer.

JANUARY 2008

The material above is intended for legitimate news entities only; it may not be used for commercial or promotional purposes. Consumer Reports(R) is published by Consumers Union, an expert, independent nonprofit organization whose mission is to work for a fair, just, and safe marketplace for all consumers and to empower consumers to protect themselves. To achieve this mission, we test, inform, and protect. To maintain our independence and impartiality, Consumers Union accepts no outside advertising, no free test samples, and has no agenda other than the interests of consumers. Consumers Union supports itself through the sale of our information products and services, individual contributions, and a few noncommercial grants.

Consumer Reports

CONTACT: Tildy La Farge, +1-914-378-2436, mlafarge@consumer.org orLauren Hackett, +1-914-378-2561, lhackett@consumer.org, both of ConsumerReports

Web Site: http://www.consumerreports.org/

Source: PRNewswire-USNewswire

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