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Health care industry forces family impoverishment: UCPA witness testifies on access to health insurance.

Health Care Industry Forces Family Impoverishment: UCPA Witness Testifies on Access to Health Insurance

On September 19, 1990, UCPA witness Donald Penzenik of South Bend, Indiana, testified before the House Energy and Commerce Subcommittee on Commerce, Consumer Protection, and Competitiveness, chaired by Representative Doug Walgren (PA). At a hearing entitled "Access to Health Insurance: Who is 'Medically Insurable'?" which focused on Representative Walgren's bill, H.R. 2649, Federal Health Insurance Equity Act of 1989, Mr. Penzenik testified about his eight year-old son Michael who has multiple disabilities.

Donald Penzenik opened his testimony by describing his family:

"My name is Donald Penzenik and I live in South Bend, Indiana with my wife, Vickie, and our three children, ages 11, 8 and 4... My wife and I were high school sweethearts and have been married for 15 years. We were both born and raised in the State of Indiana; that is where we have our roots and our extended family.

We have three children: Jeffrey, age 11, Michael, age 8, and Steven, age 4. Michael was born on June 3, 1982. He is a child with multiple disabilities -- his diagnosis is colpocephaly (a brain malformation), hypotonia, seizure disorder, scoliosis, with a communication disorder, mental retardation, and multiple developmental delays -- or in short, cerebral palsy, meaning he cannot walk, talk, dress, toilet, feed or fend for himself. Michael is physically dependent on us for his every need, and probably will be dependent upon us and others for physicial assistance and support throughout his lifetime.

As the head of a household with a child with multiple disabilities, I have learned a great deal more than I ever wanted to know about the health insurance industry and its impact on my family and thousands of families like mine.

While my wife was pregnant with Michael, my employer...was taken over in amerger by another company and I was let go... I didn't opt for the (insurance) conversion policy when the company policy ended ... because there seemed to be better coverage by purchasing a private "family" policy for myself, my wife and my son Jeffrey from Blue Cross-Blue Shield of Indiana, at a premium of $93.60 per month..."

Between June 1982 and April 1986 the following sequence of events forced the Penzenik's to impoverish themselves to qualify for Medicaid coverage for their son.

* Blue-Cross Blue-Shield insurance premiums increased 175 percent in a twelve-month period;

* After being rehired by a prior employer and restored to a prior plan, uncertainty about the future led Mr. Penzenik to retain the Blue-Cross-Blue Shield policy as a personal expense;

* Attempts to add Michael to the family plan were ignored by Blue Cross; instead he was enrolled as an individual policy holder on a separate policy with a $1,000 deductible, with a "1.XVXV benefits code;

* Blue Cross continued the family, minus Michael, in a policy with a $250 deductible with an "XRR benefits code";

* After collecting monthly premiums of $50.43 for Michael and $112.31 for the rest of the family for a period of time, Blue Cross cancelled both policies, stating in a form letter to all policyholders in Indiana they could no longer afford to administer the plan;

* The re-hire by the previous employer and acceptance into the Company's self-insured health benefits followed by a termination created a sense of panic and led to a choice not to purchase a conversion plan for fear the premium would be too high;

* All health insurance coverage lapsed until Mr. Penzenik was employed by a small firm where he was informed that the company health insurance plan would not cover Michael "because of his health conditions." He therefore withheld Michael's name from the application for insurance, in effect denying his son's existence so that the rest of the family could have health insurance coverage;

* Unable to buy insurance for Michael because no one in Indiana was selling it, Mr. Penzenik stated "The health insurance industry forced me to turn to Medicaid." To qualify, all family assets, savings, individual retirement accounts, and life insurance policies were 'spent down' leaving the family impoverished, unprotected and vulnerable to financial disaster.

* A current employer provides a group plan that covers all the family, except Michael. Medicaid has paid for Michael's wheelchair and a custom seat insert, a total of $5,400 (or $350 per month since Medicaid covered him). Medicaid denied payment for the lift necessary to get Michael's wheelchair into the family van saying it was not "medically necessary." Private charities, other family members and friends contributed $3,430 for a used wheelchair lift. The family sacrificed Medicaid's respite care allowance for one year so that the $600 allowed could be used instead for the lift.

Mr. Penzenik says they have been stigmatized and excluded, they have "suffered" and will continue to suffer until the health industry is compelled to modify or eliminate current underwriting principles. Because of their commitment to raise their son with disabilities at home, they "are not very free to pursue economic growth and the American Dream." Instead they are compelled to:

* set financial restrictions on their standard of living;

* deny themselves additional education and career advancement;

* forgo saving for their children's college educations and their own retirement;

* forsake any inheritance from other family members.

Donald Penzenik pointed out the contradictions in P.L. 101-336, The Americans With Disabilities act, signed by President Bush July 26th this year, where it is stated,

"It is the purpose of this Act -- (1)to provide a clear and comprehensive national mandate for the elimination of discrimination against individuals with disabilities...and (4) to invoke the sweep of Congressional authority, including the power to enforce the Fourteenth Amendment and to regulate commerce, in order to address the major areas of discrimination faced day-to-day by people with disabilities," and yet,

"Insurance -- Titles I-IV of this Act shall not be construed to prohibit or restrict --

(1) an insurer, hospital or medical service company, health maintenance organization, or any agent, or entity that administers benefit plans, or similar organizations for underwriting risks, classifying risks, or administering such risks that are based on or not inconsistent with State law."...

He concluded his testimony by calling on Congress "... to pass legislation during the 102nd session of Congress to include the insurance industry and employers who self-insure within the spirit and intent of the ADA, so that public resources will only be used for those individuals and families who are financially unable to access our preferred vision of non-discriminatory health insurance access."
COPYRIGHT 1991 EP Global Communications, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1991 Gale, Cengage Learning. All rights reserved.

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Title Annotation:Family Support Bulletin; United Cerebral Palsy Association
Author:Bergman, Allan I.; Simpson, Jenifer
Publication:The Exceptional Parent
Date:Jan 1, 1991
Words:1084
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