Health care reform in California is in stall mode right now, and with each passing day the price tag for gathering signatures rises.  But between the twin fundraising efforts of the Speaker and the Governor, as long as they cancel travel for a month they should be fine.

What’s working against the proponents of health care reform, in my view, is the continuing tragedy of Nataline Sarkysian.  By November 2008 this will be out of the headlines, but within weeks the State Senate will be debating the merits of a reform measure that keeps the insurance companies in business to do this:

A Friday funeral was set for the Northridge teenager who died last week after her insurer refused to pay for a liver transplant and then reconsidered. Meanwhile, the girl’s health plan stood by its initial decision Monday.

Philadelphia-based Cigna HealthCare has a record of approving coverage for more than 90% of all transplants requested by its members, as well as more than 90% of the liver transplants, company President David Cordani said in a memo addressed to employees and distributed to members of the media.

This is definitely a time to be citing statistics.

CIGNA clearly makes decisions based on corporate profit and lawsuit threats.  They decide what treatments are “experimental” based on flowcharts and spreadsheets, not by looking into their customer’s eyes.  And their complete lack of empathy proves that they’re willing to let this continue.

Just the other day, a state appeals court ruled that insurers cannot play the game of canceling coverage because of faulty applications only when the patient actually needs to use their health care.

California health insurers have a duty to check the accuracy of applications for coverage before issuing policies — and should not wait until patients run up big medical bills, a state appeals court ruled Monday.

The court also said insurers could not cancel a medical policy unless they showed that the policyholder willfully misrepresented his health or that the company had investigated the application before it issued coverage […]

The decision came in a closely watched case involving Steve Hailey, an Orange County small-business owner whose coverage was canceled by Blue Shield of California after he had a disabling car accident. The ruling in favor of Hailey sends the case back to the lower court for trial and requires Blue Shield to pay Hailey’s appellate costs.

The types of tricks of the trade employed by CIGNA and Blue Shield are a nationwide trend.  Legislation and lawsuits have yet to stop them.  They’ll claim that they can’t do business without this kind of chicanery.  At some point, government must grant their request.

(Tragically, the girl in question, Nataline Sarkisyan, died yesterday evening after this diary was posted. nyceve at Daily Kos has more about the netroots’ role in forcing CIGNA to capitulate. – promoted by Robert in Monterey)

I am pasting a release below about the Dec. 20 “Patient’s Revolt” that forced heartless CIGNA corporation to approve the liver transplant that could save the life of 17-year-old Nataline Sarkysian.

It’s been an emotional day involving hundreds of people, but there are a couple of lessons I want to take away.

First–we have power.  We shouldn’t be afraid to use it.  A unique coalition of the California Nurses Association/National Nurses Organizing Committee, a union, together with netroots and the Armenian Community shamed a global insurance corporation into doing the right thing.

Second–we shouldn’t have to do this…and every candidate pushing to mandate individuals purchase insurance products from the likes of CIGNA, who would still be in the business of profiting through the denial of care, should think long and hard.  Are the CIGNA’s of the world really the people who should control our healthcare dollars?

Here is the full release.  Highlights:

CIGNA CAPITULATES TO PATIENT REVOLT

Following Massive Protest, Insurer Authorizes

Transplant for 17-year-old Nataline Sarkysian

CNA/NNOC-Sponsored Protest Sparks Flood of Calls from Across U.S.

In a stunning turn-around, insurance giant Cigna has capitulated to community demands, and protests that the California Nurses Association/National Nurses Organizing Committee helped to generate, and agreed to a critically needed liver transplant for Nataline Sarkysian, a 17-year-old girl in the intensive care unit at UCLA Medical Center.

A national web of friends and family of Nataline, CNA/NNOC registered nurses, doctors, members of the Armenian community, healthcare advocates and netroots supporters pitched in on an unprecedented national day of action on Nataline’s belief.  

The centerpiece of the protests was an impassioned rally today sponsored by CNA/NNOC with the substantial help of the local Armenian community that drew 150 people to the Glendale offices of Cigna. Hundreds of phone callers clogged the lines of Cigna offices around the country, all demanding that Cigna reverse its prior denial of care.  

“This is an incredible turnaround generated by a massive outpouring around the country that proves that an enraged public can make a difference and achieve results,” said CNA/NNOC Executive Director Rose Ann DeMoro. “Cigna had to back down in the face of a mobilized network of patient advocates and healthcare activists who would not take no for an answer.”

The netroot protest was organized by Eve Gittelson an influential health policy blogger who writes on Daily Kos as nyceve, and many of the calls were also the product of work by the Armenian National Committee.

“Natalie is now seriously ill and still has significant hurdles in her fight for her life, but thankfully our combined voices and protests have finally given her and her family hope,” said Geri Jenkins, RN, a member of the CNA/NNOC Council of Presidents who works in a transplant unit at the University of California San Diego Medical Center.

“However, it is deplorable and appalling that CIGNA needed to have hundreds of people pounding on their doors and besieging them with calls to take the humanitarian step they should have done long before today,” said Jenkins who spoke at the Glendale rally.

Nataline’s mother, Hilda Sarkisyan, expressed her profound thanks to CNA/NNOC. “We couldn’t have done this without you helping us to stand up against this insurance company and forcing them to finally do the right thing. It is not right in this country for it to take a rally, a protest, and a major press conference to get an insurance company to listen.”

“Every politician who thinks the answer to our healthcare crisis is more insurance should stop and think about Nataline Sarkysian,” said DeMoro. “Insurance is not care. Paying for insurance coverage is not the same as assuring you will receive appropriate care, even when recommended by a physician as it was for Nataline. Insurance corporations profit by denying care to the sick, and that is no way to run a humane healthcare system.”

DeMoro said that CNA/NNOC will continue to encourage patient protests and publicize stories about insurance companies’ denial of care, as it has all year through its www.guaranteedhealthcare.org web site, while pressing for real healthcare reform “that takes medical decisions out of the hands of insurers and places them where they belong, in the hands of healthcare professionals and their families.”