One purpose of the healthcare reform effort in Washington is to help more Americans obtain coverage, in part by making policies available to people with preexisting conditions. But the pending bills wouldn't end the nightmares faced by others whose insurance fails them when they need it most.
The problem starts with the 35-year-old Employee Retirement Income Security Act, a federal law that regulates the pensions, retirement savings programs and other benefits provided by private employers, guilds or unions. ERISA imposes two of the same requirements on employers' group insurance policies that Congress wants to apply to the individual insurance market: no denials of coverage and no increase in premiums for individuals with preexisting conditions. But it also exempts employers from state rules mandating which types of treatments must be covered and protects employers and their insurance partners from most damages if a policyholder's treatment is wrongfully delayed or denied. Patients can go to federal court and try to force the insurer to pay for the treatment, but, as Times staff writer Lisa Girion has pointed out, that's cold comfort for the families of those who die waiting for the dispute to be resolved. State regulators may levy fines against some insurers that act unfairly on a broad scale, but they don't have the wherewithal to respond to individual patients' complaints.