Protecting the Health Care Consumer

US PIRG

The Problem: Consumers pay too much for too little coverage

Americans pay a lot for their health coverage

• Employer based health premiums have doubled since 2000.
• Employer-provided health insurance for a family of four now costs $12,100/year

But they aren’t getting their money’s worth, because government has let
insurer put their profits before people. In most states, big insurers continue to:

• Deny or delay coverage for pre-existing health conditions
• Rescind coverage after care has been delivered
• Impose lifetime limits on coverage
• Require outrageous premiums and excessive cost-sharing from some consumers

The Solution: Guaranteed, Affordable Health Care
Congress must demand that insurers give every American consumer five simple
guarantees
I. Guarantee that coverage won’t be lost due to illness or job status

• No denial, delay, or revocation of coverage due to pre-existing conditions or illness (Guaranteed issue and renewal)
• Individuals can keep their coverage when changing jobs
• Ban revocation of an insurance policy after it has gone into effect, for unintentional errors (non-fraudulent recissions).
• Prohibit excessively low lifetime caps on coverage

II. Guarantee coverage choices that everyone can afford

• Curb excessive premiums and cost-sharing
• Outlaw discrimination in coverage and pricing based on health status or history

III. Guarantee that premiums go to care, not profits or executive perks;

• Require that at least 85 cents of every premium dollar goes to health care, not administrative costs, executive compensation, or excess profits
• Require detailed, public disclosure of insurance company business practices

IV. Guarantee a fair hearing for anyone who is denied needed care

• Mandate independent appeals processes for consumers to quickly appeal insurers’ decisions to deny care
• Protect patients right to sue insurers for denying medically necessary care