[Congressional Record Volume 142, Number 41 (Friday, March 22, 1996)]
[Extensions of Remarks]
[Pages E419-E420]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




   WHY WE NEED THE KASSEBAUM-KENNEDY GROUP-TO-INDIVIDUAL CONVERSION 
                               PROVISIONS

                                 ______


                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                        Thursday, March 21, 1996

  Mr. STARK. Mr. Speaker, over the years, I've received many letters 
from around the Nation on the need for national health insurance 
reform.
  Many of these writers would be helped by a provision in Kassebaum-
Kennedy: the right to buy an individual policy after leaving a group 
policy, and not having one's pre-existing conditions excluded 
permanently. Many insurance companies oppose this provision but passing 
this law is the least we can do for our constituents.
  The following letters make the case:

       Dear Mr. Congressman, I am a 50-year-old male who was 
     recently laid off due to a corporate merger. I have continued 
     Cobra health insurance program through my former employer, 
     for myself and wife, at my own expense of $281 per month.
       I have accepted a position with a small company and applied 
     for the medical insurance offered by them with John Alden 
     Life Ins. Co. This has been in process for several weeks, and 
     I have now received this enclosed letter refusing us coverage 
     due to my ``condition''.
       I have had a seizure disorder since my late teens which is 
     totally controlled by medication and has not incapacitated me 
     at any time. I am periodically checked by the doctor and lead 
     a perfectly normal and active life.
       This is the first time during 30 plus years in the work 
     force with previous employers that I have ever been refused 
     medical coverage. It imposes an extreme financial burden on 
     us, and the ultimate horror is that we could be wiped out 
     should there be any medical crisis which can happen to anyone 
     at anytime.
       What, Mr. Congressman, can be done about something like 
     this, and where do we turn when suddenly judged uninsurable?
                                            A Man From California.
                                  ____

       Mr. Stark: As a retired employee of Southeast Banking 
     Corporation, my medical coverage ceased on September 20.
       First, I believe it is outrageous that retired employees be 
     advised after the fact that coverage was terminated, and not 
     given the opportunity to seek alternative coverage in a 
     timely manner.
       Further, since Southeast was self insured and Metropolitan 
     was merely the administrator, there is no policy to which we 
     can convert.
       Furthermore, I am advised by Metropolitan that due to a 
     pre-existing condition (Parkinson's) of my wife, they have no 
     coverage available for her and that they doubt if any insuror 
     in the country would write coverage. And the Florida 
     Insurance Commissioners Office claims that they have no 
     jurisdiction over self-insured groups, plus enrollment in the 
     State assigned risk program has been closed.
       So, the long and the short of it is, we are out on the 
     street. What am I to do?
                                  ____

       Dear Congressman Stark, I am sure that you would be 
     interested and concerned about what has recently happened to 
     me as an older, retired adult, in relation to an extreme 
     inequity in the health care system. What happened to me is as 
     follows.
       I retired as a result of a heart problem in 1989, and in 
     1990, I had a bypass surgery. I was covered by Kaiser 
     Permanente Health Plan at the time, and I have been covered 
     by them for the past 32 years. I was still carried by the 
     engineering company from which I retired, but without my 
     knowledge, my company discontinued the Kaiser health plan as 
     of June, 1992. Not having been notified by either my ex-
     employer nor Kaiser, I continued to use the medical services, 
     and even had an elective hernia operation in June. On June 
     26th, Kaiser sent a letter notifying me that I was no longer 
     covered. Upon contacting them by phone, I was told of the 
     circumstances, and was advised to apply under an individual 
     membership. I complied and immediately applied, but I was 
     rejected quickly by the Medical Review Board at Kaiser citing 
     the reason as ``arteriosclerotic heart disease''.
                                              Man From California.
                                  ____

       Dear Congressman Pete Stark, I'm 13 years old and, a 
     resident of San Leandro, California. When I was 10 months old 
     my pulmonary artery had to be opened. At that time I had 
     Health insurance. Unfortunately, after I recovered from the 
     open heart surgery, my families insurance dropped my 
     coverage. Due to the fact that my parents are self-employed, 
     I have been without Health insurance for roughly 12 years.
       Thank you for your time.
                                      Deborah From Hayward, Calif.
                                  ____

       Dear Rep. Stark: My husband and I have been what we would 
     call middle class for all our married life. We both held down 
     good paying jobs and worked hard all our life. Two and one-
     half years ago I had three heart attacks in one month. I 
     could no longer work for quite some time, having spent many 
     weeks in the hospital. My husband has been treated for 
     hypertension for some years, and it became obvious he must 
     sell our business because of this and his worry over me, plus 
     the fact that I could no longer work with him at our 
     business. This was an unprofitable sale, business was poor 
     and we had to share the proceeds with a partner in our 
     business. He applied for and was paid Unemployment Comp. for 
     several months until he obtained work. Since he returned to 
     the workplace at age 59, it was very difficult to secure a 
     well paying position, but he is a hard worker and he can 
     provide for our needs at this time, except for health 
     insurance coverage. I have returned to work part time only, 
     as my health does not permit me full time employment. After 
     paying into Unemployment for the eight (8) years we were in 
     business, he has now been notified he was not eligible to 
     collect unemployment at all, because the Unemployment Board 
     decided he did not have good cause to sell the business and 
     therefore, demand a repayment of $3,000 he was paid. We are 
     appealing this ruling, but I have gotten far afield of my 
     subject I am afraid . . .
       As we had group health coverage for both of us and our 
     employees in our business, we have kept up that coverage 
     until this month. We have been covered by Prudential Ins. for 
     approximately 10 years. Each six (6) months the premium was 
     raised 15 percent until this month it went to $576 per month. 
     We have been paying this premium each month from our savings 
     (from the sale of the business and it was intended to be for 
     our retirement). But now it has been depleted and we no 
     longer can pay for the coverage. We have been unsuccessful in 
     locating other coverage because of the two year wait for 
     ``pre-existing'' conditions, I for my heart problems, he for 
     hypertension. Also, not being in a ``group'' the cost was as 
     much as we were paying Prudential for a group coverage.

[[Page E420]]

       I am very apprehensive about the fact that if either of us 
     becomes ill enough for hospitalization, we will be shunned 
     aside because we have no insurance. My medication is very 
     expensive, realizing a total expense of over $300 per month, 
     and my husbands hypertension medication is $68 per month. We 
     are struggling to make ends meet with these drug expenses and 
     other obligations in this depressed economy.
       There is no where to turn it seems. We have an ``insurance 
     pool'' here in Fla. for people like us without insurance, but 
     having looked into it, we would be paying far more for this 
     coverage than we have been to Prudential, and we would be 
     waiting for the 2 year waiting period for ``pre-existing'' 
     conditions again.
                                             A Woman From Florida.
                                  ____



                                   Consumers for Quality Care,

                                  Los Angeles, CA, August 8, 1994.
       Dear Member of the California Congressional Delegation: 
     Just last week, on August 2, the Ninth Circuit ruled that 
     ERISA preempts one of California's most important consumer 
     protections: the requirement that insurance companies 
     continue to pay health insurance benefits to a sick or 
     injured patient even if the patient's participation in a 
     health insurance plan is terminated by an employer or 
     insurance company.
       If ever there was an example which illustrates why Congress 
     should amend ERISA as part of health care reform, this case 
     is it.
       Vanessa Serrato was eighteen years old, a high school 
     student with a promising future, when she was struck by a 
     drunk driver. During subsequent surgery to amputate her leg, 
     Vanessa went into cardiac arrest. She suffered profound and 
     permanent brain damage, and lapsed into a coma.
       At the time of the accident, Vanessa was in a position that 
     one would assume to be enviable: she was covered by not one, 
     but two health insurance policies. One was issued by 
     Massachusetts Mutual Life, under a policy provided to her 
     mother by her employer; the other by John Hancock Mutual 
     Life, under a policy issued to her father by his employer. 
     The Mass Mutual policy provided $1 million in benefits; John 
     Hancock's policy offered unlimited benefits. Both policies 
     promised to cover the needs of a catastrophically injured 
     patient like Vanessa.
       Less than one year after the accident, however, 
     Massachusetts Mutual Life terminated Vanessa's coverage when 
     her mother's employer ceased operations in California. At the 
     same time, John Hancock terminated her health care benefits 
     when her father's employer substituted a different insurer 
     for John Hancock. California's case law requires, as a matter 
     of public policy, that patients who are injured or fall ill 
     during the period when a policy is in force and reasonably 
     expect that their policy will provide long term benefits are 
     entitled to continue to receive the benefits. But both 
     insurers refused to pay for the medical treatment and 
     services Vanessa desperately required.
       The young woman, who was entitled to coverage under two 
     policies, instead was left with nothing. Her mother takes 
     care of her at home; Vanessa's poor condition reflects the 
     fact that she has not received the care she needs.
       Vanessa Serrato's parents brought suit on her behalf 
     against both health insurers and the employers through whom 
     the insurance was provided. She argued that under 
     California's vesting law, once she became disabled her right 
     to the benefits vested, and the insurance companies could not 
     terminate that right. She asked that her medical bills be 
     paid, and that the companies pay her attorneys' fees for 
     having to bring a lawsuit. But the federal district court 
     dismissed the case, ruling that California's vesting rule is 
     preempted by ERISA under the U.S. Supreme Court's 1987 
     decision in Pilot Life v. Dedeaux. . . .
           Sincerely yours,
     Jamie Court,
                                       Consumers For Quality Care.
     Maria Ferrer,
                                                    Health Access.
     Harvey Rosenfield,
                                                Consumer Advocate.
     Gerri Dalleck,
                                    Center For Health Care Rights.
     Terry McBride,
     Consumers For Safe Medicine.

                          ____________________