KOBI: 2-Year Transplant Hold in Rulebook for New Oregon Health Insurance Enrollees

KOPB TV | Oct. 30, 2013 1:37 a.m. | Updated: Oct. 30, 2013 8:58 a.m.

Contributed By:

Christine Pitawanich

There is yet another hitch in the rolling out of the Affordable Care Act. First it was the online registration system that couldn’t get running on time. Now the latest hiccup is hitting Oregon hard with potentially deadly consequences.

2-Year Wait Time for New Oregon Health Insurance Enrollees

That’s because on January 1, 2014, newly covered Oregonians who need transplants will have to wait two-years to get one. It’s just one more hurdle in a string of potential problems that legislators are forecasting, as the state tries to work out the details of the complex changes to our healthcare system.

According to officials in Oregon’s Insurance Division, come the first of the new year, the state will be the only one with a two-year waiting period for people needing transplants. The only other state with a delay is Washington, but there it’s six months.

Why Is the 2-Year Waiting Period in the Rulebook?

To be in compliance with the ACA, Oregon had to choose an existing insurance plan to use. The problem?

“Embedded in this huge plan with all kinds of benefits, thousands of benefits, was the two-year wait,” began Senator Alan Bates (D-Medford).

“It’s a sort of technical barrier that needs to be taken away,” he continued.

Cheryl Martinis, a spokesperson for Oregon’s Insurance Division said most plans in Oregon prior to the ACA, already had a two-year hold for people in need of transplants; That’s how it made it into Oregon’s new healthcare system.

Senator Bates said the practice originated when insurance companies did not want to accept people with pre-existing conditions.

“What the insurers were worried about was people buying insurance just because they have a specific illness,” he explained.

Is the 2-Year Delay Allowed Under ACA?

So the next question: Is the two-year hold permissible under the Affordable Care Act? Officials in the Oregon Insurance Division as well as Senator Bates don’t believe it is. Bates said the rule is discriminatory.

In fact, he said insurance companies aren’t supporting the two-year wait either since it’s more cost effective for people to get transplants as soon as possible, rather than pay for prolonged medical treatment until two-years are up.

Bates, who is also a doctor, said time is crucial when dealing with transplants.

“These are life saving issues,” he began.

“The most important as far as time is concerned […] bone marrow transplants and liver transplants. Kidney transplants you have a little time to play with cause you have them on dialysis.”

Officials Seek Public Comment

But officials say a change is in the works with a public hearing scheduled in Salem for December 4th at 9am.

That’s where it’ll be important for Oregonians to weigh in and do their part in changing a rule that come January 1st, may hold up transplants for people who desperately need them.

Other Options to Make Sure Your Voice is Heard

If you cannot make it to the public hearing in Salem, you can mail your public comment to the following address:

Oregon Insurance Division
Attn: Victor Garcia
P.O. Box 14480
Salem, OR 97309-0405

For more information on proposed rule changes that are being looked at, visit the Oregon Insurance Division website:

http://www.cbs.state.or.us/ins/rules/prop_admin_rules.html

People interested in getting more details on how to make a public comment or any other information can call 503-947-7260.

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