Health Insurance

San Marcos resident Maggie Yount wasn't surprised when the letter from insurance giant Anthem Blue Cross arrived the other day. Yet she couldn't help but be frustrated. "Some medical conditions, either alone or in combination with the cost of medication, present uncertain medical underwriting risks," Anthem informed her. "In view of these risks, we find we are unable to offer you enrollment at this time." In other words, no health coverage for you.

Earl Richardson's medications were running out, his feet were swelling and he felt a hard bulge in his stomach. His wife told him he couldn't wait any longer. He must see a doctor. It had been almost a year since the 56-year-old lost his tech support job after it was outsourced to India. He had gone without seeing his internist, dermatologist, dentist and optometrist for months because he could not afford costly COBRA health continuation benefits.

It might have looked as if real progress toward healthcare reform was made last week when leading insurers proposed ending their long-standing practice of charging higher rates to sick people and denying coverage to those with chronic conditions. But not so fast. A closer look at the insurance industry's plan reveals a potentially huge loophole that could short-circuit genuine reform.

One of the casualties of last year's budget fiasco in Sacramento was a bill that would have made it harder for health insurance companies to rescind coverage after a customer undergoes expensive treatment -- a noxious practice that Times reporter Lisa Girion has been chronicling for more than three years. In his 2008 State of the State address, Gov.

Not surprisingly, questions remain -- and will continue -- on the decision to subsidize COBRA health insurance benefits for some people who recently lost their jobs, and with it, their health coverage. This element of the recently enacted stimulus bill offers eligible individuals a 65% reduction in their premiums for up to nine months. We asked Kirby Bosley, senior health benefits consultant for consulting firm Watson Wyatt in Los Angeles, to answer two for us.

Maribel Pantoja sat nervously on an examination table, awaiting word from her doctor about a painful wound on her left leg. Because she speaks only Spanish, there is usually an added level of anxiety when she visits a clinic. But a new first-in-the-nation state law requiring health insurers to provide interpreters for members with limited English skills spared Pantoja the confusion of trying to communicate with her doctor Tuesday.

Calling access to healthcare a moral and spiritual imperative, Los Angeles religious leaders and their flocks are urging congressional leaders to include illegal immigrants in any healthcare reform plan. More than 100 parishioners attended a Mass of " hope and reconciliation" last week at Our Lady Queen of Angels church and launched a phone bank to convey to elected officials their support for an all-inclusive healthcare plan. "If we were politicians, this would be definitely political suicide to come out for healthcare reform for those who are undocumented," said Father Roland Lozano, pastor of the church near Olvera Street, known as La Placita.

Los Angeles is the epicenter of the nation's crisis in health insurance coverage. One in four residents of the city is uninsured for all or part of the year, based on our analysis of the 2007 California Health Interview Survey. Contractors who work on city projects contribute to this problem because many don't provide affordable health insurance to their employees. Contractors at Los Angeles International Airport are among the big companies that fail to provide affordable healthcare.

The prospects for reforming the U.S. healthcare system brightened this week when the country's top insurers made a significant concession to consumer advocates: They offered to stop basing premiums on a policyholder's medical history. Although the concession came with strings attached, it removes one of the hurdles facing lawmakers as they struggle to overhaul the system.

Health Net Inc. has agreed to pay California hospitals at least $1.95 million for care delivered to patients whom the insurer later dropped. The settlement, pending a judge's approval, resolves a lawsuit filed by California hospitals to recover payments they say the Woodland Hills company improperly withheld after canceling the coverage of hundreds of patients.