Public And Administrative Law: Legal Method And Process

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Joe Q. Public and Administrative Law
Shannon M. Heffner
LS500: Legal Method and Process
Professor Nancy Patete
June 12, 2012

Often times, insurance companies and state funded insurance providers deny individuals healthcare coverage on account of a preexisting medical condition they have. This practice was accepted as being justifiable and no one thought twice about it being prejudicial against individuals having medical problems. Some individuals, including Joe Q. Public, are only offered minimal coverage, excluding any services or procedures pertaining to their preexisting medical condition. This coverage is referred to as limited coverage and those receiving even limited coverage with a preexisting medical condition are lucky, as most people are denied coverage completely. In the case of Joe Q. Public, he is claiming that his state is depriving him of his human rights by preventing him from obtaining health insurance coverage. The state is denying Joe Q. health insurance coverage based on his preexisting diagnosis of diabetes. On June 22, 2010, the Department of Health and Human Services (HHS), the Department of Labor (DOL), and the Treasury issued new interim final regulations to implement a new health care reform "Patient's Bill of Rights" under the Affordable Care Act (www.healthcare.gov). The premise of the Affordable Care Act was to return power to consumers to retain control of their health and ultimately their healthcare. The Patient’s Bill of Rights provides American citizens with the tools and information they need in order to make informed decisions about their healthcare. A new found flexibility and stability restores hope to consumers that was severely lacking prior to the creation of the Patient’s Bill of Rights. Initially, the Patient’s Bill of Rights addressed ten issues, but was expanded by two more issues affording more rights and protections to patients. The Patient’s Bill of Rights addresses the following issues: provides coverage to Americans with preexisting conditions, protects your choice of doctors, keeps young adults covered, ends lifetime limits on coverage, ends preexisting condition exclusions for children, ends arbitrary withdrawals of insurance coverage, reviews premium increases, helps you get the most from your premium dollars, restricts annual dollar limits on coverage, removes insurance company barriers to emergency, covers preventative care at no cost to you, and guarantees your right to appeal (). The first issue addressed by the Patient’s Bill of Rights is relevant to Joe Q. Public’s request for health insurance coverage and denial by the state due to his prior diagnosis of diabetes. Although Joe Q. has a preexisting condition of diabetes, under the Affordable Health Care Act and the Patient’s Bill of Rights he still has the ability to be insured. While some private insurance providers have the liberty to refuse individuals from receiving health insurance coverage, there is an alternative for those refused called the Pre-Existing Condition Insurance Plan (PCIP). The Pre-Existing Condition Insurance Plan emerged when President Obama signed the 2010 Affordable Care Act. It allows those consumers who were previously denied health insurance coverage due to preexisting medical conditions the opportunity to now obtain health insurance coverage. Prior to the passing of the Affordable Care Act, many consumers with preexisting medical conditions were either charged ridiculously high premiums or denied coverage all together. Some consumers had health insurance coverage, but it excluded treatment for their preexisting condition. Although Pre-Existing Condition Insurance Plans are available to insure consumers temporarily, not all individuals are eligible to participate in PCIP’s. As with all other insurance providers, there are criteria that must be met in order for an individual to be eligible to participate. Some of the basic criteria of PCIP’s are: you must
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