Md. panel urges wider health insurance accessibility

November 05, 1994|By John Fairhall | John Fairhall,Sun Staff Writer

In an effort to help more Marylanders obtain health insurance, a state task force recommended yesterday several steps to make individual policies more affordable, easier to obtain and harder to cancel.

The recommendations would affect Marylanders who can't obtain insurance through employers or other groups.

About 300,000 people now hold individual policies, and another 600,000 have no insurance. Many of them might benefit from the recommendations.

If the recommendations are followed by the General Assembly, insurers would be required to offer a comprehensive benefits package identical to the one the state has directed insurers to offer to small businesses and groups.

Although insurers could impose a 12-month waiting period for coverage of existing medical conditions of new subscribers, insurers would have to guarantee renewal of policies, even if the subscriber runs up big bills for illness.

Consumers also couldn't be denied benefits, or forced into a new waiting period, if they switch from one insurer to another -- assuring that their benefits are portable.

"I think it's absolutely a forward step for consumers, because it assures there are more opportunities for individuals" to obtain coverage, Russell R. Dickhart, a task force member and Aetna insurance official, said of the recommendations.

Yet the recommendations fall well short of the goal of some task-force members who wanted to guarantee every Marylander, including the very sick, prompt access to affordable health insurance.

A proposal to require insurers to take all comers -- without onerous waiting periods for coverage -- was rejected for fear it would backfire by driving up the cost of insurance for all people.

Susan Cohen, a consumer member of the task force and program director of the Epilepsy Association of Maryland, argued strongly for such a guarantee. "It is fair and nondiscriminatory to all individuals who do not have access to group benefits," she said.

Ms. Cohen noted that the only insurance option some Marylanders have now is to wait for "open enrollment," a period twice a year in which Blue Cross and Blue Shield of Maryland and some other insurers agree to accept any applicant.

The proposal before the task force would have assured Marylanders access to insurance throughout the year, possibly at a lower price than people can obtain through open enrollment.

But she joined a majority of task force members in voting for the package of recommendations, which will be considered next month by the Maryland Health Care Access and Cost Commission, the agency overseeing the task force. The goal is to have the General Assembly act in its next session, which begins in January.

Another recommendation would require insurers to price coverage on the basis of "community rating," a way of spreading the risk over a large group of people and avoiding exceptionally high premiums for selected groups of people.

Within limits, insurers would be permitted to vary rates by age and geography.

A highly controversial recommendation permits insurers to offer policies in addition to the standardized policy that small employers and groups are now required to offer.

Proponents of the recommendation said it is necessary to offer consumers less expensive alternatives to the standardized policy.

Ms. Cohen argued that the recommendation could lead to segmentation of the insurance market, resulting in higher prices for some people, and higher administrative costs.

The 16-member task force includes representatives of consumer groups, insurers, the Maryland Insurance Administration, small and large employers, doctors and hospitals.

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