Federal investigators have told Reuters that WellPoint, the country's largest insurance company, is using an algorithm to identify women with breast cancer for the express purpose of dropping their coverage.
Murray Waas writes that WellPoint "specifically targeted women with breast cancer for aggressive investigation with the intent to cancel their policies":
The women all paid their premiums on time. Before they fell ill, none had any problems with their insurance. Initially, they believed their policies had been canceled by mistake.
They had no idea that WellPoint was using a computer algorithm that automatically targeted them and every other policyholder recently diagnosed with breast cancer. The software triggered an immediate fraud investigation, as the company searched for some pretext to drop their policies, according to government regulators and investigators.
Wellpoint claimed that these women had made material misrepresentations in order to justify dropping their coverage, but Waas says they were dropped "based on either erroneous or flimsy information." Last week, Waas reported that AIDS patients were being similarly targeted for recision.
The version of health care bill passed by the House of Representatives would've allowed these women to apply to an "independent external third party" for review before being dropped. It also would have required Wellpoint to keep their coverage in place until the board made its determination, and policies could only be canceled in cases with "clear and convincing evidence of fraud."
Those provisions were not included in the Senate Finance Committee bill, however, which became the basis for the final health care bill signed by the President. Reuters says that Wellpoint lobbyists "helped quash proposed provisions that would have required a third party review of its or any other insurance company's decision to cancel a customer's policy."
As Marcy Wheeler reported last year, the Senate Finance Committee bill was written by former WellPoint VP Liz Fowler, who left her position at the insurance company in February 2009 expressly for the purpose of helping the committee to draft the health care bill:
And when Max Baucus did a "victory lap" after the health care bil passed, he expressly thanked Fowler for her work:
I wish to single out one person, and that one person is sitting next to me. Her name is Liz Fowler. Liz Fowler is my chief health counsel. Liz Fowler has put my health care team together. Liz Fowler worked for me many years ago, left for the private sector, and then came back when she realized she could be there at the creation of health care reform because she wanted that to be, in a certain sense, her profession lifetime goal. She put together the White Paper last November-2008-the 87-page document which became the basis, the foundation, the blueprint from which almost all health care measures in all bills on both sides of the aisle came. She is an amazing person. She is a lawyer; she is a Ph.D. She is just so decent. She is always smiling, she is always working, always available to help any Senator, any staff. I thank Liz from the bottom of my heart. In many ways, she typifies, she represents all of the people who have worked so hard to make this bill such a great accomplishment.
Susan Bayh, wife of Indiana Senator Evan Bayh, is on the WellPoint board. Bayh threatened to join Joe Lieberman in a filibuster of the health care bill if a public option was included, something that would very much threaten WellPoint profits -- which have soared in the past year. Susan Bayh's compensation for her role on the WellPoint board includes valuable stock options.
Before the health care bill passed, Harry Reid promised Bernie Sanders that there would be a vote on the public option "in the coming months," and anonymous "hill aides" said that they were looking to use the reconciliation process, such that only 50 Senate votes were needed for passage. In exchange, Sanders offered to give up on his plans to offer a public option amendment. A public option would mean that at the very least, breast cancer and AIDS patients who were unfairly dropped from private insurance plans had some place to go for medical coverage.
But the Senate budget committee is marking up next year's budget right now, and according to the Hill, there are no plans to include reconciliation instructions for health care. Which means that for the next year, any plan to "fix it later" would require 60 votes in the Senate -- but the public option doesn't have 60 votes. Which means Reid punk'd Sanders, Jeff Merkley and other progressive Senators to secure their votes.
It's shameful that Wellpoint lobbyists were successful in keeping key protections for those with breast cancer, AIDS and other serious illnesses out of the Senate bill. But it's even more shameful that Harry Reid has no intention of keeping his promise to fix the health care bill any time soon -- and that members of the Senate with serious conflicts of interest will profit handsomely as a result.
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