Last Week’s Tragic Killing of a Health Insurance Executive and the Unfinished Business of Patient Rights
A Wake-Up Call for Washington and the Nation
Last week’s shocking killing of UnitedHealthcare’s chief executive, Brian Thompson, reopened a national wound inflicted by the delay and denial of health coverage to countless Americans. This was a violent crime that won’t solve anything. But the ensuing organic and spontaneous outpouring of populist anger underscored how many Americans have been cruelly and unjustly denied medical treatment.
A Nation’s Unfinished Business
Despite progress on healthcare coverage and rights, protecting American patients is unfinished business. In the 1990s, California pioneered a patients’ rights movement that gave those covered by HMOs a right to second opinions, independent medical reviews of coverage denials, and guaranteed coverage of certain commonly denied procedures. Many states adopted California’s model, and President Obama’s Affordable Care Act took important steps to insure the uninsured and prevent companies from denying coverage to people who want it.
Unequal Access to Justice
But America’s patients never got equitable access to justice when claims are denied. People who buy their own insurance or get it through a government job or program such as Medicare have the right to sue for damages if they believe they have been harmed by an unreasonable denial. But most of us get health insurance through our jobs and have no such right to go to court, no matter how outrageous the denial or tragic the consequences. More than 100 million Americans have no legal recourse if a health insurance company messes up their claim.
The Supreme Court’s Ruling and Its Consequences
In the 1987 case Pilot Life Insurance Co. vs. Dedeaux, the Supreme Court ruled that people with employer-provided coverage do not have a right to sue their insurer for damages but rather only for the value of the denied benefit. If the covered person dies, any suit is rendered moot. Despite many attempts to change this, including through Obamacare, the ruling has stood. That’s why insurance companies often act as if they have a license to kill: they face scant legal consequences for any harm they cause by delaying or denying payment for needed care.
Nataline Sarkisyan’s Story
A 17-year-old Angeleno, Nataline Sarkisyan, became a poster child for addressing this injustice. Nataline, who had recurrent leukemia, had to wait too long for insurance approval of a liver transplant that doctors considered likely to save her life. Her mother, Hilda Sarkisyan, protested with nurses at the headquarters of their health insurance plan, Cigna. When the company finally approved the surgery under pressure, it was too late: Nataline died in 2007, hours after the approval was granted. And because of the Pilot Life decision, the family had little legal recourse.
Conclusion
The Sarkisyans have crusaded to have the Pilot Life ruling overturned and to spare others their daughter’s fate. Congress has made it easier to obtain coverage but has yet to give patients the leverage they need once they have insurance: the right to collect damages from companies that behave horribly. This shouldn’t be hard. Congress — whose members do enjoy a right to sue over denials of their own health insurance claims — has many options for limiting the extent of insurers’ exposure to lawsuits, such as making them liable only when they show gross indifference to a patient’s suffering.
FAQs
Q: What is the Pilot Life decision?
A: The Pilot Life decision is a 1987 Supreme Court ruling that people with employer-provided coverage do not have a right to sue their insurer for damages, only for the value of the denied benefit.
Q: How many Americans are affected by this decision?
A: More than 100 million Americans have no legal recourse if a health insurance company messes up their claim.
Q: What is being done to address this issue?
A: The Sarkisyan family has been crusading to have the Pilot Life ruling overturned and to give patients the leverage they need once they have insurance: the right to collect damages from companies that behave horribly.
Q: What can Congress do to address this issue?
A: Congress can limit the extent of insurers’ exposure to lawsuits, such as making them liable only when they show gross indifference to a patient’s suffering.
