President Trump’s order to allow more competition across state lines for health care plans sounds like a very good idea. So what do critics mean when they say that plans are unregulated?
Meet Buddy Kuhl. He drove a truck for Belger Transportation. Belger offered Buddy a health insurance plan.
Buddy had a serious heart problem. His heart doctor recommended surgery.
Buddy’s health insurer disagreed with his treating physician.
Under the policy, the insurance company had the right to order two "second opinions." The insurance company chose the medical experts. Both times, the experts agreed with the treating physician—Buddy needed an operation.
But six months had passed by.
When Buddy had a pre-surgery check, the surgeon said his heart was too diseased to be fixed. Buddy was put on the transplant list.
While waiting in a St. Louis hospital for a heart, Buddy died of heart failure.
Buddy’s family sued the insurance company, alleging that it substituted a medical judgment for the first doctor who got it right.
And here is the key point: The Kuhls lost because health insurance plans were not subject to government regulation—the plan was free to order two, three, four “second opinions.”
With all its warts, the ACA was passed because too many Americans had Buddy Kuhl experiences with health insurance.
Under the new rules, Americans will experience more “benefit denial” cases compared to the ACA, where regulations constrain insurance companies (and drive up prices). And without regulations, insurers will be much freer to say no-- and patients and families will have no recourse.
For Buddy Kuhls' posthumous lawsuit (which failed), see https://www.leagle.com/decision/19931297999f2d29811235.
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