If you have a sick kid, this form letter isn’t boring

Humanity and social change, expressed through a boring form letter.

Sometime social change comes in inspiring speeches at the Lincoln Memorial, the East room of the White House, or the Senate floor. When we need to guarantee that people’s serious but complex human needs are met, we often express our humanity through boring, bureaucratic form letters Hence the attached letter from a Mr. Michael Knitter of our university benefits office. It’s the kind of letter that often finds its way straight to the recycle bin. It shouldn’t.

Boring University of Chicago benefits letter

Knitter’s letter explains changes to our insurance plan made to comply with the Affordable Care Act. Children will not be denied coverage due to pre-existing conditions. Young adult children can stay on our insurance plan until age 26. There is no lifetime limit on coverage for costly conditions such as cancer. For more on this letter, see here and here.

You can find many good pieces today which explaining the importance of health reform and the fatuousness of alleged Republican alternatives. For me, the significance of this day hit home in a more prosaic way. Thanks to health reform, including regulations that become operational today, we’ve made the University of Chicago a more humane and secure place for our friends and colleagues who struggle with health difficulties. The same is happening in countless other work places. Voters may not be quite ready to see this yet, but health reform is beginning to quietly help millions of people.

I am proud to have played a small part in this–and to have gotten the chance to take this really, really lousy picture.

From the nosebleed seats, via cellphone

Update: Igor Volsky has another nice posting and cross-tab of Affordable Care Act provisions with the GOP “Pledge to America.”

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect, tnr.com, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

10 thoughts on “If you have a sick kid, this form letter isn’t boring”

  1. That is all very nice. Good for you and your colleagues in Hyde Park! Now, what about the rest of us, even those who have employer-provided insurance, but not through an academic institution with pockets quite so deep as your particular monument to John D. Rockefeller's guilty conscience? My "private insurance market" (sic) leads to this: I have a colleague (ironically a physician) who has a genotype indicating the high probability of cancer within 10-15 years. Our "carrier" has denied coverage for the surgery that would prevent this course of events because their actuaries calculate that in 10-15 years this particular person will probably not be employed here. What about the 50,000,000 among us without health insurance of any kind? Just askin'. BTW, I do hope that Todd Henderson is as happy as you are about this letter. I'm sure it will ease his mind a bit as he contemplates his uncertain financial future. Oh, and one more question. For our fellow citizens in the individual market, I have read that the big insurers are going to get around covering children with pre-existing conditions by just refusing to underwrite that coverage. What's up with that?

  2. Unfortunately, people with preexisting conditions in the small-group and individual insurance market must wait to 2014 for the full benefit of ACA. Your colleague with cancer will be helped by the ban on lifetime benefit caps. Help is coming–It should come faster.

  3. KLG said:

    "Our “carrier” has denied coverage for the surgery that would prevent this course of events because their actuaries calculate that in 10-15 years this particular person will probably not be employed here."

    If this really happened, your recourse is to go to the state insurance website, identify the consumer contact for health insurance, call and figure out how to appeal (if the insurer hasn't included in the EOB a statement of how to appeal). This is such an aberrant (not to mention illegal) practice that it's frankly hard for me to believe it actually happened quite this way (and I am WAY cynical about this kind of stuff). Now, I could see an insurer trying to deny coverage on the basis that the surgery is preventive and not actually geared to correcting an existing health issue, especially if the deterioration is less than certain, or perhaps not even typical. This would be a more likely explanation for denial, and it should still be appealed. But to see what you wrote in an EOB, just like that? Not likely.

    As for the pre-existing conditions for children, the coverage being discontinued from new underwriting is something called a "child only" policy. I talked to some insurers and they didn't even know such policies were being written, so I can only assume it's a tiny fraction of the market. I suspect that these policies are bought most often were an employer offers employee only but no dependent coverage. But still, a harbinger of what might happen without purchase mandates of some sort.

  4. P.S. The only conditions I can think of where there is "corrective surgery" for a prospective cancer are prophylactic mastectomy or oopherectomy, with positive BRCA genes and/or family history. I honestly don't know much about how coverage of this is treated under law or insurance practice, but I would be happy to investigate for you.

  5. Thank you, both, for the replies. Work intrudes and I have only just now checked my usual sites, so I have been slow to respond. Barbara, your supposition about the cancer biology and treatment option is correct. Apparently the insurer decided initially that the surgery is preventive (or elective) and not indicated by the diagnosis. Which is just one reason why being left to the tender mercies of for-profit insurance conglomerates will not work. Period. A mastectomy now, or 5 years worth of devastating, expensive, ultimately futile "care" in 10 years? Some market-based choice that is. I have been told that the decision has been reversed, but only after the intercession of high-ranking administrators. What galls me is that this stunt was tried on a person with the means to fight the decision. What if the patient had been a custodian or cafeteria worker, barely literate and scared of the bureaucracy? The question answers itself. As for children in the individual market being a small group, that is undoubtedly so. And statistics apply to large numbers, not individuals. But when it is your child with the number, statistics offers slight comfort.

    I am a long-time lurker and sometime commenter who even had an email or two quoted by Mark in the pre-comment days of the RBC. You are all correct that the president is better than the alternative. But he could have been so much better, if only he had actually meant what he said during his campaign. I'll have to repeat myself: Had he fought hard and publicly for the "public option" he ran on and been defeated by GOP and Blue Dog intransigence, we would be preparing to make history in a few weeks. And the GOP in its current incarnation would be ready for the ash heap of history. Instead, a once in a lifetime opportunity has been squandered. Alas.

  6. KLG, if you think it's tough being subject to the tender mercies of private carriers, just wait until you have to deal with the "public option." Which is inevitable, by the way, unless the bill is repealed and replaced. There is no way to economically underwrite pre-existing conditions. Given that and the other rules HHS is writing there will be no more "insurance" provided by private carriers under this regime, they will be merely claims adminstrators (probably not in that business very long either). Of course, this is what health reform advocates wanted all along.

    Some day, you might look back fondly on your U of Chicago plan.

  7. Redwave72, I am completly at a loss to understand what you're saying. You do realize that there is no public option in the bill, right?

  8. Well, there were no death panels either but that didn't stop anyone identifying with the radical "Right" from claiming it were so.

  9. No there is no public option now, but there will be once the state exchanges go in place and the private carriers have dropped out of the market because there is no profit in it. That is, unless the bill is repealed / changed first. Between the MLR's and the ban on pre – exisiting conditions, there is no way private carriers will continue to provide real insurance.

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