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Small Businesses and the Self-Employed Need Stronger Coverage Protections for Pre-Existing Conditions

National Patient Advocate Foundation supports new small business health initiative but urges strengthened pre-existing condition provision

WASHINGTON, April 15 PRNewswire-USNewswire — The National Patient Advocate Foundation (NPAF) today endorsed new Senate legislation, Small Business Health Options Program (SHOP), but called for stronger protections to protect patients with pre-existing conditions.

According to NPAF CEO and President Nancy Davenport-Ennis, "The SHOP proposal is a significant step forward for patients — but it falls short in protecting those with serious, life-threatening and/or disabling disease who are often excluded from health coverage because of pre-existing conditions."

"NPAF applauds Senators Dick Durbin (D-IL), Norm Coleman (R-MN), Olympia Snowe (R-ME) and Blanche Lincoln (D-AR) for their leadership in acknowledging that small businesses and the self-employed are finding it increasingly difficult to obtain and maintain health insurance coverage for themselves and their employees," said Davenport-Ennis. "Unfortunately, their legislation does not go far enough for individuals and families dealing with pre-existing conditions."

The National Patient Advocate Foundation (NPAF) — a national, non-profit organization dedicated to creating avenues of patient access to health care through state and federal public policy reform — through its companion direct patient services organization, the Patient Advocate Foundation (PAF), has seen a steep increase in the number of patients facing individual coverage problems such as rescissions, disputes involving pre-existing condition exclusions and other access-related issues.

As a result, NPAF has been working with leaders in the Congress on legislation that limits to a maximum of three months any pre-existing condition exclusion. Congressman Joe Courtney (D-CT) and Senator Jay Rockefeller (D-WV) have introduced companion legislation (H.R. 2833 & S. 2236) which reduces the permissible pre-existing condition exclusion periods from twelve months to three months, reduces the "look-back" period from six months to 30 days, and applies pre-existing condition protections to the individual health insurance market. (A three month pre-existing condition exclusion period is consistent with the waiting periods for state-qualified health plans under the Trade Adjustment Assistance program.)

The SHOP legislation is also limited in only covering small employers and certain self-employed individuals, and does not protect other consumers in the individual market.

"NPAF is encouraged by the recognition that twelve months is far too long for patients to endure without coverage for their pre-existing conditions," said Davenport-Ennis. "We look forward to working with SHOP sponsors and other health care stakeholders to expanding the bill's protections to all health care consumers."

National Patient Advocate Foundation (NPAF) is a national, non-profit organization that is dedicated to the mission of creating avenues of patient access through improved access to, and reimbursement for, evolving therapies, therapeutic agents, and devices through policy and legislative reform at the state and federal levels. Our mission is shaped by the experiences of the patients served through our companion organization, Patient Advocate Foundation.

SOURCE National Patient Advocate Foundation

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