Another human face of health reform: Nora Kenny gets insurance unrescinded, despite congenital “mandibular hypoplasia”

Yeah that means “overbite.” Beginning this year, insurers can’t rescind kids from coverage on the basis of this or or more serious concerns. Lives are already changing for the better. That’s something to celebrate.

Yeah that means “overbite.”

The Chicago Tribune’s Bruce Japsen reports that 17-year-old Nora Kenny got her health insurance back, thanks to Illinois regulators. Her coverage had been rescinded by Blue Cross and Blue Shield of Illinois, which “said in letters in late 2008 to the parents and their orthodontist that they uncovered a 2001 diagnosis of mandibular hypoplasia.” Kenny’s father is a self-employed lawyer. So her family purchases insurance in the wild-west market for individual and small-group coverage.

“It really put us in a vulnerable position,” Nora Kenny’s mother, Kathy, said of the Blue Cross rescission. “You felt since we’re small potatoes, they can peel you off one by one. We had no leverage of paying millions of dollars in premiums like a General Electric.”

It’s not clear whether the Kenny family should have revealed Nora’s, er, congenital condition. Two things are clear, though.

First, families such as Nora’s will now face less worry. So will families with worse conditions to worry about than one which may support an orthodontist’s Caribbean vacation. The Kenny family got relief through a somewhat ambiguous state law, now interpreted under the shadow of national health reform. Beginning September 23, the Affordable Care Act bars every insurer in America from discriminating in child coverage on the basis of preexisting conditions. It also bars the accompanying rescissions (with specific exceptions for consumer wrongdoing).

Second, Nora Kenny’s comments are exactly right. That same Blue Cross and Blue Shield of Illinois did a great job when my wife required a prolonged hospital stay. Unlike the Kenny family, mine is covered through a large employer. This provides our insurer (and thus us, too) with a stable, relatively healthy risk pool that reduces pressures for underwriting. It provides administrative efficiencies which lower costs. Not least, my family is represented by a university benefits department so that we do not have to deal as individual patients and consumers with health providers and behemoth insurance companies.

Health reform is complicated. ACA’s key pieces–including the individual mandate and insurance exchanges—are designed to give people like Nora Kenny the same protections my own orthodontic-festooned daughters enjoy.

We’ll have many bumps in the road to health reform, particularly before 2014 when ACA’s main pillars become operational. It’s important to note that lives are already being changed for the better, one family at a time. That’s something to celebrate in a tough time.

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.

6 thoughts on “Another human face of health reform: Nora Kenny gets insurance unrescinded, despite congenital “mandibular hypoplasia””

  1. This is a point that can't be made often enough. Those other 2 "legs of the stool" that make so many people uncomfortable – mandates and the exchanges – were essentially compromises with the insurance industry so that we could get everyone covered.

    The essential political philosophy behind all this is that access to healthcare is a kind of right, and it is unfair to ask private businesses to shoulder this burden. We don't ask grocers to give food to the poor. We don't ask private schools to give away education for free. But because we believe in some basic right to education, or to not starve, we have the state step in. Forcing for-profit insurers to cover people with pre-existing conditions is essentially asking them to bear a social burden.

    Another way to think of this is how other forms of insurance work. Denying auto insurance coverage based on a history of bad driving seems perfectly reasonable. First, lack of auto insurance has a negligible effect on one's life. Second, it is much more clearly the case that the individual was making poor choices, as opposed to simple bad luck or genetic predisposition.

  2. "Another way to think of this is how other forms of insurance work. Denying auto insurance coverage based on a history of bad driving seems perfectly reasonable. First, lack of auto insurance has a negligible effect on one’s life. Second, it is much more clearly the case that the individual was making poor choices, as opposed to simple bad luck or genetic predisposition."

    Another great example of how cloudy people's thinking is re: insurance. The parasites that run the insurance industry have done an awesome job of obscuring their role as non-essential middlemen and using their lobbying power to entrench themselves.

    The problem with denying people auto insurance for "poor choices," is that it's the OTHER guys who suffer when Joe Dipwad is uninsured. Joe is so poor that he can't afford insurance and, in a real sense, has no insurable interest. His car isn't worth squat. He has no assets that can be taken from him by a judgment. Why should Joe pay for auto insurance?

    Since the physical act of driving is unconnected to being insured, there are a LOT of uninsured drivers out there — and how convenient for the parasites, who get to sell you ANOTHER overpriced product (uninsured/underinsured motorist coverage)! The statistic I saw around 1999 was 12% — I would bet money that has gone up significantly.

    The only rational approach to the auto insurance market is to provide coverage for all drivers by a fee connected to the fuel supply (which means that even unlicensed drivers will be paying it) — a per-gallon fee would go to a state liability fund that would cover the costs of collision damages. People who wanted to insure their own vehicles against theft and other risks would be free to do so on the private market — but nobody would have to buy insurance to cover the risk that Joe Dipwad would run a red light and t-bone them (as happened to a friend of mine, who is undergoing her second surgery now).

    The state would auction off calibrated even-risk blocks of drivers, say 5,000 at a chunk, to insurance companies for servicing claims. The companies would bid for the right to service blocks of drivers by offering to do so for $X per block, and would be responsible for all claims-handling by the drivers or anyone involved in an accident with them. Every year, anyone who has had to make a claim would be surveyed to rate the servicing company – good scores are rewarded at bid-renewal time, poor scoring servicers are penalized.

    Presto — no more marketing expenses or stupid advertising (a HUGE savings), insurance companies do what they're efficient at, and EVERYBODY gets insurance against catastrophic loss — where everybody means EVERYBODY, not just the law-abiding. Better yet, it converts what is now a spendy fixed cost (insurance) to a variable cost, so that people who conserve on driving or who pay for fuel-efficient vehicles (which also cause less harm to others) are rewarded with savings instead of punished.

    I know this is tangential to the original post, but it so clearly illustrates why we're screwed with the so-called health reform: insurance companies making a profit on health care are the problem, not the solution, and trying to treat a cancer without removing these parasitic tumors is simply a waste of time. TR Reid's book does an excellent job showing that many other countries have found solutions that work much better than our system, providing universal coverage at much lower cost. The one difference is that they either eliminate insurance companies or regulate them so that basic health coverage is not a profit center.

  3. Harold,

    Your link to the story doesn't work. I went to the tribune and read the initial story and the follow up, and did not find mention of "mandibular hypoplasia." I did however find that the insurance Co. rescinded coverage based on "alarming" pre-existing conditions such as fatigue, dizziness, and coughing. I'm glad that Libertarians are fighting the good fight to preserve our right to be sick, and for insurance companies to add bankruptcy and financial ruin to our increasingly infringed upon liberty.

  4. Thanks DaMaverick. I fixed the link. It indeed has the reference to mandibular hypoplasia.

Comments are closed.