His plans for comprehensive health reform are on life support in Congress, but President Obama can help improve coverage for 132 million Americans just by a stroke of his pen, according to a consumer advocacy group.
Obama should close a legal loophole that currently prohibits 132 million Americans from holding their health insurance providers legally accountable for denials and delays of care"even if those denials or delays result in serious injury or death, according to the organization, Consumer Watchdog.
Consumer Watchdog also asked Obama not to wait for Congress, but to re-establish a special assistant for consumer affairs in the White House"a post that the organization says every other Democratic president since John Kennedy has filled to be a voice for patients who lack legal remedies against insurance companies.
At issue are denials of coverage insurers issue to those covered under employer plans — often for catastrophic conditions. The TV magazine Dateline NBC recently broadcast an expose on the matter, which was referenced by Consumer Watchdog.
The report highlights several instances of families seeking serious care for their loved ones in the face of insurer intransigence, including the case of 57-year-old Florida firefighter Rick Crusoe. Crusoe developed a rare, virulent cancer. He missed the window for an effective treatment because his insurer wouldn’t approve it. Crusoe died a short time later, according to the report.
Consumer Watchdog says that privately insurance company employees admit that the companies are more likely to delay and deny treatment to workers covered by private employers, because they face no consequences because they have no legal recourse.
"Before Wednesday’s State of the Union address, we urge you to review Sunday night’s edition of Dateline NBC, which features three families who suffered deeply for lack of enough legal leverage to get medical treatment promised through their employer-sponsored health insurance," the representatives from Consumer Watchdog ask Obama in a letter to the White House. "Any of the 132 million Americans with such insurance coverage could find themselves in similar straits: with health coverage but without care they desperately need, because they have no adequate legal remedies when they fall seriously ill and are wrongfully denied treatment."
The dilemma of these families stems in large part from a 1987 Supreme Court decision, Pilot Life vs. Dedeaux, which "is widely regarded as a misinterpretation of Congress’s intent" in enacting the Employee Retirement Income Security Act (ERISA), the letter says.
The letter urges Obama to call on Congress to fix this inequity that leaves individuals "at the mercy of insurers’ delays and denials of necessary care."
The organization also wants the president to take an immediate step that does not require action by Congress: the creation of a consumer affairs office in the White House.
"One benefit of this representation for consumers would be its power to speak for patients who cannot seek justice in our courts, yet lack other effective advocacy on their behalf. A consumer affairs advocate in the White House would be heard by insurers and could make sure federal agencies are more responsive to patients’ needs," the letter says.
