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Health Coverage

Question:

My twenty-three year old son has been diagnosed with bipolar disorder and has had great difficulty the last year. He has been unable to hold a job or attend college part time. Since he is not a full time student he can no longer be on our insurance we have him on the cobra plan but it is getting very expensive Kaiser has turned him down for coverage due to a prexisting condition. Are there any laws that protect the mentaly ill? How do people get health coverage?

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Answer:

The health insurance system in the United States is in serious crisis – on this point everyone agrees except for the health insurance companies. Some level of minimal health care ought to be a human right – but sadly it is not. As private for-profit businesses, health insurance companies only want to sell policies to people who are healthy. If they sell health policies to sick people, those people are likely to require expensive health care which would eat into profits. Your son was denied necessary coverage because if insurance companies granted such coverages on a routine basis, they might be less profitable than they are today. The way I understand it, whether or not a given ‘sick’ individual will be denied coverage by a health insurance company depends on how coverage is being sold, and in what state it is sold. I believe (but don’t hold me to this) that all states require that if coverage is sold to a group (such as a business or professional association), that insurance companies are required to include and insure all persons within that group regardless of their health status. When insurance is sold on an individual basis, however, each state has different laws as to whether it is legal for an insurance company to deny someone the opportunity to purchase a policy based on pre-existing conditions. I believe it is illegal to do so (deny coverage for pre-existing conditions) in Vermont, South Dakota and a few other states (although they can still charge you an arm and a leg for said coverage). I believe it is entirely legal to discriminate on the basis of pre-existing conditions in most other states. This web page says that it has information on the laws for each state (but I don’t know how up to date or accurate this page is).

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p> Even if you move to a state where your son is able to purchase health coverage, he may find that because he has a ‘mental’ condition (e.g., a neurological one) rather than a ‘regular’ medical condition, that he will still be discriminated against. This is becuase there are few or no laws requiring mental health parity. Becuase of historical prejudice and ignorance, health insurance companies are allowed to discriminate against mental illnesses by offering reduced payments for treatments for mental conditions. This is ‘justified’ becuase years ago the medical establishment did not consider mental illnesses to be real illnesses but rather moral failures or instances of demon possesion. No legitmate physician today would make these claims, but the practice continues today beacause it is legal for the health insurance companies to get away with it. President Bush had made a few noises a while back in the direction of mandating pairity for mental illnesses within the health care system, but he never did anything substantial and hasn’t seemed to think about the issue in a long time.

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p> The answer to your question is basically that the situation is grim. There are a few laws that protect the ill (of any stripe), but these are mostly state laws that exist in only a minority of states. In the absence of private health insurance, there is the public health system and the community mental health system, but as you might guess, this community resources are typically very underfunded themselves, only working with the very most severe cases they can find. Social workers in your community can help you to understand what is possible for your son within these systems. If you don’t like your options, the only constructive advice I can give you is to become an advocate for some form of (at least minimal) universal health coverage and for mental health parity.

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