WASHINGTON — Ending insurance discrimination against the sick was a central goal of the nation’s health care overhaul, but leading patient groups say that promise is being undermined by new barriers from insurers.
The insurance industry responds that critics are confusing legitimate cost-control with bias. Some state regulators, however, say there is reason to be concerned about policies that shift costs to patients and narrow their choices of hospitals and doctors.
With open enrollment for 2015 three months away, the Obama administration is being pressed to enforce the Affordable Care Act’s antidiscrimination provisions. Some regulations have been issued; others are pending after more than four years.
More than 300 patient advocacy groups recently wrote Health and Human Services Secretary Sylvia Mathews Burwell to complain about some insurer tactics that ‘‘are highly discriminatory against patients with chronic health conditions and may . . . violate the (law’s) nondiscrimination provisions.’’
Among the groups were the AIDS Institute, the American Lung Association, Easter Seals, the Epilepsy Foundation, the Leukemia & Lymphoma Society, the National Alliance on Mental Illness, the National Kidney Foundation, and United Cerebral Palsy. All supported the law.
Coverage of expensive drugs tops their concerns.
The advocates also say they are disappointed by how difficult it has proved to be for consumers to get a full picture of plans sold on the new insurance exchanges. Digging is often required to learn crucial details such as drugs covered, exact copayments, and which doctors and hospitals are in the network.
Washington state’s insurance commissioner, Mike Kreidler, said ‘‘there is no question’’ that discrimination is creeping back. ‘‘The question is whether we are catching it or not,’’ added Kreidler, a Democrat.
Kansas’ commissioner, Sandy Praeger, a Republican, said the jury is out on whether some insurers are back to shunning the sick. Nonetheless, Praeger said the administration needs to take a strong stand.
‘‘They ought to make it very clear that if there is any kind of discrimination against people with chronic conditions, there will be enforcement action,’’ Praeger said. ‘‘The whole goal here was to use the private insurance market to create a system that provides health insurance for all Americans.’’
A Health and Human Services spokeswoman said the department is preparing a formal response to the advocates and stressed that today’s level of consumer protection is far superior to what existed before President Obama’s law, when an insurance company could use any existing medical condition to deny coverage.
The law also takes away some of the motivation insurers have for chasing healthy patients. Those attracting a healthy population must pay into a pool that will reimburse plans with a higher share of patients with health problems. But that backstop is under attack from congressional Republicans as an insurer ‘‘bailout.’’
Compounding the uncertainty is that Washington and the states now share responsibility for policing health plans sold to individuals.