Protecting the Health Care Consumer

Last updated: 1/5/2012

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
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

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