[Congressional Record Volume 148, Number 136 (Wednesday, October 16, 2002)]
[Senate]
[Pages S10575-S10576]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. GRAHAM (for himself and Mr. Fitzgerald):
  S. 3119. A bill to amend the Public Health Service Act to ensure the 
guaranteed renewability of individual health insurance coverage 
regardless of the health status-related factors of an enrollee; to the 
Committee on Health, Education, Labor, and Pensions.
  Mr. GRAHAM. Mr. President, I am pleased to introduce the ``Health 
Insurance Fairness Act of 2002'' and I am very pleased to have Senator 
Fitzgerald join me as an original cosponsor. This legislation would 
prohibit the insurance practice of reunderwriting at renewal, thereby 
protecting the millions of Americans relying on individual health 
insurance policies.
  The need for this legislation was brought to my attention by an 
excellent April 9, 2002 article in the Wall Street Journal that 
documented the impact of reunderwriting on a married couple from 
Florida.
  Shaneen Wahl of Port Charlotte, FL was diagnosed with breast cancer 
in 1996. At that time, she and her husband Tom were paying $417 a month 
for health insurance. In addition to coping with cancer, the Wahls 
began to face rapidly increasing premiums, and by August 2000 their 
insurer informed them that their new rate would be $1,881 a month. This 
premium increase wasn't due to non-payment of premiums or any other 
action of the Wahls. It was the result of reunderwriting conducted by 
the Wahl's insurance company.
  Reunderwriting at renewal is a practice that forces people who have 
become ill to pay substantial premium increases or lose their health 
insurance. While most insurers evaluate an individual's medical history 
only at the outset, some have adopted the practice of reviewing 
customers' health status annually. The purpose of this review is to 
determine if the individual has developed a medical condition or has 
filed claims; if such a determination is made, the company raises the 
individual's premium. This practice contributes enormously to the 
instability of health insurance by making it difficult, it not 
impossible, for people who have paid insurance premiums for years to 
continue that health insurance at the very time they need it the most.
  How does it work? Carriers reunderwriting at renewal charge 
substantially higher renewal premiums to policyholders who have been 
diagnosed with an illness or had medical claims than they charge other 
policyholders. The carriers do this by transferring a policyholder to a 
higher risk class than the policyholder was in when the policy was 
issued or in some cases by manually adjusting the policyholder's rate 
based on his or her medical claims. In either case, the individual's 
premium is based on his or her claims or health status during the 
policy year. For example, in another case from Florida, Bruce and Wanda 
Chambers of St. Augustine saw their rates increase from $300 per month 
to $780 per month in just one year after Wanda was diagnosed with 
diabetes.
  Consumers purchase insurance so that they will have access to health 
care should they become ill, as in the example of Wanda Chambers. If 
carriers are allowed to increase premium rates based on health status 
at renewal, consumers face a choice between the very two outcomes they 
had

[[Page S10576]]

planned to avoid by purchasing insurance in the first place: they can 
drop the insurance policy and thus likely forgo access to health care 
in times of illness, or they can pay the grossly inflated premiums and 
thus face financial ruin.
  The practice of reunderwriting at renewal violates the spirit of 
health insurance guaranteed renewability requirements under state and 
federal law. In the 1990's, the National Association of Insurance 
Commissioners, NAIC, developed model laws to prohibit insurance 
companies from canceling policies once an individual became sick. In 
1997, the Health Insurance Portability and Accountability Act, HIPAA, 
applied this requirement to all health insurance policies subject to 
HIPAA. As a result, carriers can no longer cancel individuals because 
of their medical claims.
  Reunderwriting is a way to circumvent these requirements, and has 
been justified as a means of holding down premiums, for the healthy. 
However, a July 17, 2002 memo to all NAIC Members from Steven B. 
Larsen, Chair of the Health Insurance & Managed Care (B) Committee 
clarifies that the practice of reunderwriting is illegal under NAIC 
Model Laws:

       The committee also noted that the practice is contrary to 
     adopted NAIC policy, and is illegal under NAIC Model Laws 
     governing the individual market. The Small Employer and 
     Individual Health Insurance Availability Model Act (Model 
     #35) provides for adjusted community rating, and health 
     status is not one of the factors that can be used to set 
     rates. The Individual Health Insurance Portability Model Act 
     (Model #37) provides for the use of rating characteristics, 
     and health status is not one of the listed characteristics. 
     More specifically that model also provides that changes in 
     health status after issue, and durational rating, are not to 
     be used in setting premiums for individual policies.

  Insurance companies should not be allowed to manage health-care costs 
by targeting individuals for premium increases because an individual 
was diagnosed with an illness or has had medical claims. Doubling or 
tripling premiums for only the individuals who have been diagnosed with 
an illness forces those individuals to drop their policies and is 
functionally the same as not renewing coverage.
  Not only is reunderwriting bad for consumers, but it creates a 
competitive disadvantage to the many reputable insurance companies that 
agree that this practice is contrary to the public interest and 
undermines the theory behind insurance. Faced with the practice being 
used by some companies, the Wall Street Journal has reported that other 
carriers are ``closely watching'' this practice intending to adopt a 
similar practice either to avoid a competitive disadvantage or to 
improve their bottom line. While selective targeting improves the 
profitability of the reunderwriter, it shifts the responsibility for 
higher risk people to other insurers or employers or local and state 
government health programs.
  The legislation we are introducing today would make health insurance 
more secure. The legislation would clarify that guaranteed renewal of 
health insurance means that insurers cannot target individuals for 
premium increases because the have had claims or a new disease 
diagnosis. The bill would ensure that individuals will not be priced 
out of the market for health insurance at the very time that they need 
it most.
  The goals of this legislation are simple: 1. To strengthen HIPAA's 
promise of guaranteed renewable coverage and make private health 
insurance more secure for millions of Americans, and 2. to hold all 
insurers accountable to a level playing field of reasonable standards 
so they can compete fairly without dumping customers when they get 
sick.
  The ``Health Insurance Fairness Act'' will help the many millions of 
people who rely on the individual health insurance market: those that 
are self-employed, those employed by small businesses unable to get 
group coverage, early retirees who rely disproportionately on 
individual health insurance if their COBRA runs out before Medicare 
begins, and others whose employers don't provide health benefits.
  I urge my colleagues to cosponsor the ``Health Insurance Fairness 
Act'' and I thank the Chair.
                                 ______