The Real Reason That the Cancer Patient Writing in WSJ Lost Her Insurance
More: The Real Reason That the Cancer Patient Writing in Today’s Wall Street Journal Lost Her Insurance
Monday’s Wall Street Journal features an op-ed from Edie Littlefield Sundby, a stage-4 gallbladder cancer survivor who won’t be able to keep the coverage she currently has. Her insurer, United Healthcare, is pulling out of the individual health care market, forcing Sundby to find new coverage in California’s health care exchange.
But the plans available through Cover California don’t offer in-network coverage for all of the care Sundby needs. As a result, she has to choose between her two health care providers if she wishes to remain in-network. “Stanford has kept me alive—but UCSD has provided emergency and local treatment support during wretched periods of this disease, and it is where my primary-care doctors are,” she writes:
What happened to the president’s promise, “You can keep your health plan”? Or to the promise that “You can keep your doctor”? Thanks to the law, I have been forced to give up a world-class health plan. The exchange would force me to give up a world-class physician.
But Sundby shouldn’t blame reform — United Healthcare dropped her coverage because they’ve struggled to compete in California’s individual health care market for years and didn’t want to pay for sicker patients like Sundby.
The company, which only had 8,000 individual policy holders in California out of the two million who participate in the market, announced (along with a second insurer, Aetna) that it would be pulling out of the individual market in May. The company could not compete with Anthem Blue Cross, Blue Shield of California and Kaiser Permanente, who control more than 80 percent of the individual market. “Over the years, it has become more difficult to administer these plans in a cost-effective way for our members,” UnitedHealth spokeswoman Cheryl Randolph explained. “We will continue to keep a major presence in California, focusing instead on large and small employers.”
The two insurers were also operating at a tax disadvantage in the state. As California Insurance Commissioner Dave Jones explained, “One of the factors I believe contributed to this decision….is the special tax break that California law gives to Anthem Blue Cross and Blue Shield, which has allowed and continues to allow those two companies to avoid paying $100 million in state taxes a year.” “Aetna and United Healthcare don’t get the special tax break provided to Anthem Blue Cross and Blue Shield, and so they faced a major competitive disadvantage in California.”
Stephen Helmsley, CEO of United Healthcare, received over $34 million in compensation last year.
According to UnitedHealth’s proxy, Hemsley’s compensation for 2012 was below the median [WTF!] for the company’s peer group. “The Compensation Committee and Mr. Hemsley agree that the total compensation awarded is sufficient to retain and motivate him,” according to the proxy.
