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Adequate coverage is needed more than ever

By Dr. Sunita Dodani

When Hampton Roads residents go for their doctor’s visit, care for COVID-19, or a serious health issue such as a heart attack or cancer treatment, they should not have to worry whether their health insurance will cover their care. They should not have to worry if their insurance will cover their necessary prescriptions, prenatal care or other essential health services — especially now.

Our state and country are facing a public health crisis, and everyone in Hampton Roads deserves quality, comprehensive health insurance that includes patient protections, covers an expansive network of providers and services, and provides simple and clear information about costs and coverage.

Earlier this year, the Virginia General Assembly voted to strengthen some, but not all, patient protections in a type of insurance called Short-Term Limited Duration plans. Although they are intended as temporary, gap-filling coverage, because of their cheap premiums STLD plans entice younger, healthier people, but they offer flimsy coverage that often does not include basics like prescription drugs and can deny coverage based on pre-existing conditions.

While the American Heart Association applauds the legislature for taking some steps to strengthen patient protections in the current law, it does not go far enough. The bill that is sitting on the governor’s desk is missing a critical component: clear, comprehensive consumer disclosures.

Consumer disclosures are a critical patient protection since they would ensure Virginians fully understand what is or is not included in the coverage they are considering with a Short-Term Limited Duration plan — which too frequently provide a substandard level of benefits. Consumers should have easy, understandable, transparent information about the coverage limitations they may experience when purchasing STLD plans.

When a patient with an ACA-compliant plan recovers from a heart attack, their average cost is $7,900 six months following diagnosis. The same diagnosis and recovery will cost a patient with a Short-Term Limited Duration Plan $32,100 to $51,300. That is a dramatic cost difference, yet one that too many find themselves in because STLD plans do not require disclosures, and consumers purchase insurance plans lacking the adequate coverage they may need. Requiring such plans to include clear consumer disclosures is a critical patient protection to address these life-changing deficiencies.

Governor Northam has the authority and opportunity to strengthen this critical legislation. Buying health insurance should not be tricky or complicated. When someone signs up for a short-term plan, they should be able to see in writing what the coverage does and does not include to make an informed decision and prevent surprises and denial of care when they most need it. An amendment from the governor to include consumer disclosures in short-term will protect the health of all Virginians now and for years to come.

Dr. Sunita Dodani is a board member of the Hampton Roads American Heart Association and professor and founding director of the Healthcare Analytics and Delivery Science Institute (HADSI) at Eastern Virginia Medical School.