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The Spokesman-Review Newspaper
Spokane, Washington  Est. May 19, 1883

Opinion

Our View: Fortunately, policies, rules can be changed

Insurance is that rare product that you buy, hoping not to get your money’s worth.

Except, of course, for the intangible value you place on peace of mind. If catastrophe strikes – in the form of kidney failure, say – at least you won’t have to scrape up half a million dollars to pay for a transplant, or do without.

If enough people feel as you do, and the actuaries have calculated the odds right, the premiums collected will be enough to pay the bills of the unfortunate few policyholders who have to collect.

The pooled-risk concept would be a flop, though, if consumers could wait until they were facing an expensive procedure and then sign up for coverage. To guard against that, insurance carriers reasonably impose waiting periods before coverage kicks in for pre-existing conditions.

But even reasonable provisions can backfire, as Fred Watley, of Spokane, found out last year when, while he was on the waiting list for a liver transplant, his employer switched to a new carrier for the workplace’s group health insurance plan. About that time Watley’s condition became more critical, but he was facing a six-month waiting period under the new plan. He didn’t have six months.

Not only was Watley’s situation grim, it was harshly unfair. He hadn’t tried to dupe anyone. He’d played by the rules.

Fortunately, the new carrier reconsidered its original denial of Watley’s claim and arranged for him to have the life-saving operation.

And fortunately for others who might have run into the same trap, Watley’s troubling experience has inspired a legislative response in Olympia. Clearly, a permanent fix is preferable to case-by-case handling of such situations. Under House Bill 1308, sponsored by state Rep. John Driscoll, D-Spokane, people who, like Watley, have had continuous health care coverage don’t have to confront a new waiting period just because the group health plan at work is shifted to a different carrier.

The bill, which had a hearing before the House Health Care and Wellness Committee on Thursday, has broad support, including from the insurance industry, and should have a clear path to eventual enactment. State law already addresses such a situation as it applies to conventional pre-existing conditions, but, as Watley discovered, it neglects to include organ transplants.

In the frequently contentious atmosphere of the Legislature, give Driscoll and his co-sponsors credit for recognizing that sometimes all the job calls for is common sense. Plaudits, too, for industry representatives who grasped the reasonableness of this bill and are lending their support.