A Consumer Guide to State Health Reform

Some health care reformers may recall that in 1994 the makers of Sim-City produced a Sim-Health computer program.  The program, labeled by some as the "dryest" simulation game ever made, allowed users to take control of the US health care system and observe the results of their decisions.   Now, taking a similar yet more user-friendly approach, Community Catalyst and Families USA have teamed up to provide health care advocates with a web-based guide for developing state expansions of health coverage. The navigable service walks you through the various steps and questions you need to ask when developing programs to expand access to health coverage, as well as quality improvement and cost containment initiatives. Topics include: expansion of public programs like Medicaid and the State Children's Health Insurance Program; regulation of private insurance; options for funding new programs; and, models for improving quality and reducing long-term health spending. To ensure anybody can take advantage of this service, the guide includes links to health care information from each state and an extensive glossary of health care terms.

Insurer Tries to Recruit Doctors in Canceling Health Insurance Coverage

Blue Cross of California, one of the state's largest health insurance companies, is being investigated for sending letters to doctors asking them to identify any medical events that could be used to cancel a new health plan membership. As we wrote in November, Blue Cross and other California insurers have already been investigated for fraudulently rescinding coverage for minor discrepancies in health insurance applications after members file a medical claim for payment. In fact, Blue Cross was fined $1.2 million after the state determined it was illegally canceling coverage by mining applications for minor errors after they had already been approved.  Compounding the insidious nature of these events, insurerers, notably HealthNet, were found to provide employee bonuses based on how many policies were cancelled.

As the San Francisco Chronicle reports, the letters to doctors, which include copies of insurance applications, say, "Any condition not listed on the application that is discovered to be pre-existing should be reported to Blue Cross immediately." The state is looking into whether this practice violates any laws, including patient privacy protections.

Americans value a close patient-doctor relationship, where you can trust that your doctor is looking out for your best interests. For their part, doctors and medical groups are decidedly disgusted by the Blue Cross actions. A spokesman for one large medical group said, "To try and turn doctors into investigators and cause them to proactively seek information and try and result in post-application denials of coverage is a perversion of the patient-physician relationship."