if you're poor, don't be autistic (or get sick)

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http://seattletimes.nwsource.com/html/localnews/2004123942_healthsurvey14m.html

Simpler health questionnaire may complicate insurance

By Kyung M. Song

Seattle Times health reporter

The penalty for being morbidly obese has gone up. Ditto for

schizophrenia and recent breast cancer. And anyone with multiple

sclerosis, severe autism or antibiotic-resistant staph infection will

now be automatically rejected.

Those are among the hundreds of changes in the latest Washington

Standard Health Questionnaire, a lengthy and mandatory

health-screening test taken by more than 100,000 state residents each

year before they can buy individual insurance coverage.

The test is designed to weed out the sickest applicants and direct

them to high-risk — and high-cost — policies.

This is the first substantial revision since the test was imposed in

2000, and will be given beginning in March for all policies that take

effect April 1.

It's shorter, with fewer vexing medical terms (goodbye

hypogammaglobulinemia) and supposedly better at reflecting actual

claims data.

But the upshot is applicants who might have aced the earlier survey

might flunk the new version. Or vice versa.

Even the questionnaire's defenders concede it's a rough tool for

predicting who will eventually rack up the biggest medical bills. The

worry now is that by asking applicants fewer and less detailed

questions, the survey could snag even more people who shouldn't be

snagged — while letting others with more serious medical problems

slip through.

Corry, a Seattle insurance executive who served nine years on

the state board that oversees the health survey, said the board

struggled to balance the need for detailed health questions and

applicants' demand for a quicker survey. Corry said it's inevitable

the revised survey will be less precise.

" The shorter it is, the more unfair it will be, almost by necessity, "

Corry said.

But the current board of the Washington State Health Insurance Pool

(WSHIP), speaks confidently that the new survey is an improvement,

designed with more current data specific to Washington state and

applying the latest knowledge in predictive modeling.

Still, they admit they won't know for sure until the test results

start coming back and they " watch closely for any skewed scoring in

early returns, " said Kären Larson, WSHIP's executive director.

Only state in nation

Washington is the only state that uses a standardized questionnaire

to screen individual-insurance buyers. Insurers are allowed to deny

coverage to applicants whose health profile puts them among the most

expensive 8 percent of roughly 270,000 state residents who have

individual coverage.

That threshold was a political compromise in the aftermath of state

changes in 1993. Health insurers in Washington were routinely

rejecting as many as 20 percent of all applicants they deemed too

risky to cover. The Legislature outlawed the practice in 1993 and

required insurers to issue policies to even the terminally ill.

Insurers responded by halting the sale of individual policies in

Washington altogether.

To lure them back, lawmakers agreed to adopt the questionnaire to

sort the sickest people into WSHIP, a high-risk pool for the

uninsurables.

People denied insurance in the open market are guaranteed coverage

through the high-risk pool. But its premiums are 10 to 50 percent

higher than comparable plans in the open market, and only about 15

percent of those referred to the pool actually enroll.

Currently, 3,400 belong to WSHIP, many with serious conditions such

as AIDS and kidney failure.

But the health questionnaire can trip seemingly healthy people. The

wrong combinations of relatively minor conditions — from acid reflux

to back sprain, nose polyps to kidney stones — can add up to enough

penalty points on the test to put customers over the limit.

Last year, about 7,000 people flunked the health questionnaire,

including more than 1,000 who successfully appealed their scores.

Responding in part to complaints the test was too long and

complicated, WSHIP hired a Denver actuarial firm to revamp it. The

survey was cut by a third, to 218 questions, and medical conditions

were simplified or combined.

The actuary also took claims records from the five largest insurers

in the state to better gauge their actual medical costs here.

Finally, it grouped separate but related treatment costs to more

accurately track the cost of an illness.

The score for failure remained at 325. But the individual scores for

a host of conditions were altered.

Diseases penalized

Multiple sclerosis, tuberculosis and lymphomas, even ones that were

treated and cured several years ago, now carry higher penalty points.

Autism and MRSA, the drug-resistant staph infection, weren't even in

the previous survey. Now they are enough for instant rejection. Same

for infants born very prematurely.

On the flip side, Alzheimer's disease, congestive heart failure or

high cholesterol get docked fewer points. High blood pressure is now

52 points, but really high blood pressure is 31 points (the applicant

presumably will get docked someplace else for related conditions,

such as vision or kidney problems).

A woman with an ovarian cyst and a fibroid tumor would fail the old

test, not the new.

All this is guaranteed to leave clients stumped, predicted Becky

Hart, president of Health Insurance Connection, an insurance agency

in Puyallup.

Hart said she keeps a medical dictionary handy just to guide

customers through the questionnaire. She complains that some medical

conditions have simply vanished from the test.

That leaves Hart guessing, for example, just what " conditions that

impact fertility or problems with the female reproductive system " are.

" I suppose I will get more comfortable " with the new survey, Hart

said. " But right now, it looks like it will be more difficult finding

the conditions our clients may have. "

Kyung Song: or

ksong@...

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