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http://www.omniture.com --> Sections Home Page Local News AP News AP Entertainment Archives Business Classifieds Event Calendar Forums Life Opinion Obituaries Photo Gallery Readers Photo Gallery Sports Tempo Weather Special Coverage 2006 Britt Festivals --> Shop Our Valley AutoFinder HomeFinder JobFinder Search Our Valley Special Sections Distinctly Northwest Readers' Choice Homelife Magazine Joy Magazine Holiday Guide Oregon Golf Info Oregon Wine Info Other Publications Local Links Ashland News eSouthernOregon Newspapers In Education Personals Moving Here Movie Listings TV Listings Volunteer Customer Service Advertise With Us Media Kit Place Classified Ad Contact Us FAQ's Home Delivery Site Map --> Email Story to a Friend January 5, 2007 Insurance is elusive even for the healthy By Lisa Girion Los Angeles Times LOS ANGELES — Scott Svonkin joined the Los Angeles County Commission on Insurance 10 years ago because he was concerned about an emerging problem: people losing health coverage. Since then, the ranks of uninsured U.S. residents have swelled to more than 46 million. Svonkin almost became one of them. It happened after he left a comfortable government job as a legislative chief of staff to start his own marketing and public affairs consulting business. Late last year he started shopping around for health insurance for himself, his expectant wife and his young daughter. He knew he'd pay more without an employer picking up most of the tab. And he knew he'd have to fill out a medical questionnaire because, unlike job-based coverage, individual insurance in California is contingent on an applicant's health. But that didn't concern him because, he said, "I'm healthy as a horse, never smoked and have had no major surgery." As it turned out, Svonkin was rejected by not just one but three of California's biggest health insurers, which cited his history of asthma, among other things. Advertisement "I couldn't buy it at any price," said Svonkin, 40. "I remember thinking, 'This can't be happening to me.' " Svonkin is part of what experts say is a largely hidden aspect of the U.S. health insurance crisis: the uninsurables, people whom insurance companies won't touch, even though they can afford to pay high premiums. Some, such as Svonkin, pay steep rates for lean coverage from the state's high-risk insurance pool. Others simply go without. Insurers have wide latitude to choose among applicants for individual coverage and set premiums based on medical conditions. Insurers say medical underwriting, as the selection process is known, is key to keeping premiums under control. "Our goal is to extend affordable coverage to as many people as we can," said Cheryl Randolph, a spokeswoman for PacifiCare Health Systems Inc., a subsidiary of Minneapolis-based UnitedHealth Group Inc. "But because of the medical underwriting, we do not accept everybody." Consumer advocates see the practice as cherry-picking — a legal form of discrimination that is no longer tolerated in schools, public accommodations or workplaces — and a way to guarantee profits. "The idea is to avoid all risk," said Bryan Liang, director of the Institute of Health Law Studies at California Western School of Law in San Diego. Jerry Flanagan, an advocate with the Foundation for Consumer and Taxpayer Rights, said it wouldn't take much to be left out of the private-insurance market. "A minor asthma condition or a surgery 10 years ago that requires no further medical care is enough to get you blacklisted forever," he said. As a result, some people forgo treatment so as not to tarnish their health records. Others withhold information from doctors or ask them to leave details out of their records. For those who are uninsurable, health care often is the chief reason they stay in or take a certain job. Uninsurable individuals pose a significant challenge for the state, which expects to spend more than $10 billion this year on people who lack adequate coverage. Gov. Arnold Schwarzenegger, preparing to announce a proposal for expanding coverage in his State of the State address, has said he favors a mandate on individuals to buy health insurance — just as drivers must carry auto insurance. Democrats, who control the Legislature, have favored expansion of employment-based insurance and have signaled their opposition to a mandate on individuals. Consumer advocates say such a mandate is unworkable unless insurers are required to sell coverage to all comers, as they are in several states, including New York and Massachusetts. No one knows how many Californians are uninsurable. Blue Cross of California, which dominates the market, declined to disclose its rejection rate, as did its chief competitors. A 2004 industry survey found that health plans said they turned away about 12 percent of all applicants. But the rejection rate rose with age to 30 percent for people 59 and older. A consumer survey this year found that 1 in 5 people who applied for individual coverage was turned away or charged a higher premium because of pre-existing conditions. Experts say it is hard to know how many of California's more than 6 million uninsured residents are uninsurable because many people with medical problems don't even bother applying in the belief that they would be rejected. The industry contends that individual coverage is widely available. But experts say a wave of consolidation has reduced the number of insurers offering individual coverage, leaving a marketplace that shuns all but the ostensibly healthiest consumers. Insurers say they are picky because they have to be. Kaiser Permanente's "fairly generous" benefits require that the health maintenance organization be restrictive to remain solvent, spokesman Jim Anderson said. "We have to be very careful to not enroll a bunch of people who are going to spend all the money on their care." Insurers declined to disclose the underwriting guidelines that lead to rejection or higher premiums. But a review of public records, as well as rejection letters sent to individuals, shows that California carriers turn people away or charge them higher premiums for conditions that range from the catastrophic to the common. Cancer, epilepsy and AIDS make the list, along with breast implants, ear infections, varicose veins and sleep apnea. Jeffrey Miles, a vice president of the California Association of Health Underwriters, a trade group for independent insurance agents, said one of his clients — a 27-year-old woman "in perfect health with absolutely nothing wrong" — was rejected because she had seen a psychologist for three months after breaking up with a boyfriend. "I call it hangnail underwriting," Miles said. "If a person has taken virtually any medication, they are going to be turned down. If people have had any psychological counseling at any time in recent history, they are going to get turned down." Consumer advocates say out-of-date, ambiguous and even erroneous medical information can render people uninsurable. Sometimes the reasons can seem absurd. In a recent letter to an otherwise healthy college graduate, for instance, Blue Cross listed among the reasons it denied coverage a past bout of jock itch, "successfully treated with cream." A last resort for people turned away by the private market is the state's high-risk pool, in which the state assumes the financial risk but pays private insurers to administer coverage. Enrollees spend as much as one-third of their income on monthly premiums that range as high as $796. Yet annual benefits are capped at $75,000. (Begin optional trim) Still, demand perennially outstrips the high-risk pool's capacity, which has been reduced over the years as medical costs have risen and funding has remained largely limited to state tobacco tax revenues and enrollee premiums. "The best estimate is it's only serving about 10 percent of the people who are medically uninsurable," said Beth Capell, an advocate with Health Access California. Most people in the high-risk pool have been rejected by at least one private insurer. Yet many turn out to be a bargain, paying more in premiums than they take out in medical expenses. (End optional trim) High-risk enrollees include people like Svonkin, who makes time for at least one tennis match each week. On a park court after more than an hour of play one recent evening, he scrambled for a ball so far out of reach most people wouldn't have bothered. After the game, Svonkin's fair skin was ruddy and sweat dripped from his forehead, but he was not out of breath. After suffering from debilitating bouts of asthma as a child, he clearly relishes the ability he now has to exercise. He credits medications that weren't around when he was growing up. But the very drugs that have allowed him to breathe freely for years may also have cost him his health coverage. Blue Shield declined to discuss Svonkin's case, citing patient privacy laws, as did the other insurers that subsequently rejected him, Blue Cross and PacifiCare. Although the rejection notices pointed to various problems — "expectant fatherhood" and swelling from a spider bite — all three blamed his history of asthma, a condition that affects more than 4.5 million Californians. Svonkin was able to enroll his wife, daughter and baby son in a private plan. But with nowhere else to turn, he reluctantly enrolled himself in the state's high-risk pool. In an ironic twist, the pool assigned him to a plan administered by Blue Shield. His premiums are $479 a month — far more than he figures he has cost the plan. The only medical expenses he has submitted in his first year on the plan have been his prescriptions, which retail for about $100 a month. Blue Shield "wouldn't take me at their risk, but they took me at the state's risk," he said. "The reasons they won't sell me insurance are ludicrous because they can still make a profit providing me with health care." The ordeal has been an object lesson for Svonkin, who is now chairman of the county commission on insurance, an advisory panel to the Board of Supervisors. He uses his post to focus on the problems of the uninsured as well as the uninsurables. The county does not regulate insurers, but its clinics, hospitals and emergency rooms are overflowing with uninsured residents who have nowhere else to turn. "Insurance companies are offloading sick people onto the county system," Svonkin said. p Would you like to respond to this story? If so Click Here to visit our forums. Advertisement Copyright © 1997-2007 Mail Tribune, Inc. All rights reserved. Privacy Policy | Terms & Conditions | Website Feedback online casinos news Home Security Systems Online Casino Reviews Men's Clothing Fundraisers UK Homeowner Loans Discount Hotel Reservations Send Flowers Casinos Canada Texas Electric Choice Compare Electric rates in Texas Windermere Van Vleet Trunks, Footlocker Online poker at AbsolutePoker.com