chemotherapy and readying himself for the transplant which @@@ 2lf for the transplant which options? >> no, there really were not. my brother's doctor was one of the most renowned doctors in the whole world on the specific routine of treatment and he had a very specific type of cancer

that really had to be treated by that doctor in that hospital at that time. and you can't just say, well, okay, you can have it a couple months down the road or you can wait. the attorney general's office realized, thankfully, because it's headed by a medical doctor, that time was of the essence. >> as well as i can recall multiple times when i was in practice, come up on these situations and you find a way to make it work for the patient. i'm frustrated in your situation because eyou were essentially allowed or offered no other option. i appreciate the fact, particularly for that type of nonhodgkin's lymphoma it may require a specialized type of care. my frustration as a physician, i cannot tell you the time that is i found another hospital or another way to make it happen

and not wait the lengths of time that you all are discussing. mrs. ms. baiten, in tarrant county there's a county hospital. did anyone ever try to help you through that tangle to try to get any care through john peter smith? >> i couldn't qualify for that. but what i did do was moved in with my sister so i could declare residency and i went to the dallas county hospital and tried to get tlep. you get on a waiting list for a mastectomy and three or four times i went there and they lost my medical records and said, why are you here. i'm here, i have cancer. i need a mastectomy. and they said we'll put you on the waiting list. i believe my name still wouldn't be on the waiting list. they never even contacted me

back. i'm thankful to say in trying to get help windy going to county hospitals and applying to county hospitals, mr. barton got my insurance reinstated and i got the original doctor. >> and i appreciate that. i believe in continuity of care and believe that that's important. again, the other aspect does not really be a part of the discussion today but it's part of the broader discussion as we talk about strategies for the future. i want to thank every one of you for being here today. ms. horton, i didn't get to you. it's not that i was afraid but i didn't have an opportunity. thank you for your testimony. it was all very important today. thank you, mr. chairman. i'll yield back. >> mr. chairman, thank you. i'll direct my questions to ms. baiten. am pr am i pronouncing it right?

>> it doesn't matter. >> ms. baiten, we heard and listened very intensely to your testimony and quite compelling and i wanted to take one quote from your written testimony and i think you said when you get on a waiting list cancer grows. and i think that was in reference to the fact that as you just testified to doctor burgess that you were on that waiting list at the county hospital. there was an alternative but, thank god that your congressman and my colleague, joe barton was able to intervene and you got the care at the private hospital and by your physician that you trusted and wanted to do the surgery. this statement you made is absolutely right. i don't know if you know it but i'm a physician, too. an obgyn doctor.

your statement is a profound one, indeed. when you get an a waiting list, cancer grows. and when we look at statistics of countries where you routinely get put on a waiting list like the uk and others, and in particular, in the treatment of breast cancer, in our country, where you don't get put on a waiting list when you have breast cancer, you get operated on quickly the five-year overall survival right for breast cancer is 98%. but in the uk system, where you frequently get put on a waiting list, a five-year survival rate for breast cancer is 78%. that's a significant change. as you described to us, that -- that 2 sent meter mass grew to 7 centimeters and low and be hold you had to have your lymph nodes removed and i guess

some of those were positive by the time you got operated on. is that the case? >> yes. >> well, let me oh we that information, let me just ask you this question. and it relates to you in particular. but it relates to everybody in general. and i'd appreciate your thoughts on ways that you think that we can strengthen the private market so that other people, anyone with chronic illness can find affordable health insurance or do you think we should turn over our health care system, lock stock and barrel to the compassion and efficiency of our federal bureaucracy? me? >> me? >> all i can say is that i did go many, many different places trying to get help and i spent hours and quit working and did all my focusing on -- instead of

focusing on getting well and my cancer, i focused on trying to get treatment and i went to every hospital in dallas. county hospitals. i went to ft. worth. i went everywhere. and i don't know how to fix it. all i know is there's something terribly wrong with the health care system. when you go to a big hospital and there's to so many people from waiting for help -- i went to all the clinics and sat with all the people that i just can't even imagine how many people are there waiting for help. you spend hours and hours, probably spend the whole day trying to see a doctor. i did that for weeks. and never got help. so the bad thing about that is when you go to different hospitals they give you 2ki6 opinions. every time i went to a different hospital my tumor was a different size. every time i went to a different hospital, one person wanted to do one thing and you get a difference in diagnosis and a

difference in treatment plans. who do you listen to? who do you know how who to listen to. all i know is when you go through this, like every one of us have been through what we've been through, you realize that something is broken. >> i'm going the reclaim my time because i just got a few seconds he want. i think you're absolutely right. there's something that needs to be fixed. something is broken and when we hear from this second panel from the insurance companies, i'm going the make some suggestions to them how we can fix this system, but it is my firm belief, ms. baiten, the other two witnesses as well, we can fix the system without, as i say, turning it over lock stock and barrel to a federal bureaucracy that routinely is going to ration and put people on the waiting list. we'll get into that later and i want to thank all three of you for being here today and giving such compelling testimony.

>> please -- some of us see this differently. but, questions? >> thank you. i had to step out to another hearing but i read your testimony this morning and so i appreciate what you've been through although none of us can really understand what it's like nobody your shoes or that of your loved ones. it's not a good thing. i want to thank -- we had two physicians here. and i think that's good. i hope at some point, given cms, cms's role in overseeing hippa,

maybe we'll have a federal agency that will have a role to come before the subcommittee as well to find out their take on what's happening. ms. horton you stated that you think the applications are deliberately confusing. i've looked through some of those and i understand what you mean. could you be a little more specific. the kinds of question that is you found difficult and confusing? >> i haven't looked at the application in four years since i first filled it out so i can't be superspecific. but i do remember them, you know, after looking at it again with my sister and brother-in-law, they both said you need to be a doctor or lawyer to figure out the application and fill it out 100% accuracy. >> how would each of you improve that application process? it seems to me that that's the crux of the argument here. there are thing that is you didn't know oh throw are things that you didn't know that were

on your loved one record that is they didn't know. how can you claim knowledge of something you have no knowledge of. that, to me is one point here. and then the second is, to know as a layperson, if you were on some medication years ago and you haven't taken it in a long time, it would be easy to forget that. or perceive that you don't even remember what it was or you don't note it or you forgot it. and, yet, we also know there are cases of fraud. and those people that were like you with individual policies, paying more because people were deliberately trying to get on the roles and the files we got indicate that. how do we get a balance here where people like you and your loved ones aren't rescinded from coverage and, yet, find this balance? it seems to get back to the initial application process and

the review of those applications and a better understanding for those of us who may be signing up for that type of health insurance 37 i'm curious, how would you fix at least that part of the process? >> anyone want to tackle that? >> i would just state that the insurance company at the time you apply for insurance, and you disclose your doctors, they have -- they should be the one that is have to do the investigations. if they don't do the proper investigation at the time you apply they shouldn't have the right to go back years later. oh three's two years -- there's a two year window for insurance companies by which they can do their investigations. no. that's wrong. they should have to investigate before they give you your insurance. they have all the opportunity to investigate then. you disclose your doctors. let them get the records. let them look at and comb the records at that time. why are they doing that later

on. >> when you have a big claim? >> pardon me? >> absolutely. if that isn't intentional, what is? they want to save money and wait until you have claims before they spend the investigative money to do what they should do at the beginning. so all this time they haven't done their job. they're taking consumer's money and the consumer thinks, i'm insured. but i'm not insured. and that's not right. that law needs to be changed. >> ms. bait snn. >> i asked, could i have a physical. i wanted to have a physical for insurance and they said, no, we don't do that. i even offered to let them do a physical which, to me, that would be a good thing this that way -- >> we have that in medicare. >> they don't do that at all because they don't want to spend the money for a physical to give

it to you to rule you out then so you don't get your hopes up and think you have insurance. >> i completely agree. i just wanted to add. after this practice happens, which hopefully we're going to stop it from happening in the first place 37 but when your physicians write letters on your behalf and aid you in apeeling to these insurance companies the 235k9 that they give no weight whatsoever to what these physicians who have been treating you for years say, you for years say, it's unconscionable. >> they said the patient would have no idea of this. it's a note i put in a file i never shared with them. and that's -- that would -- that doesn't seem right. would it be helpful -- and i realize i've run over my time here -- it seems like there's yes and no columns on these forms, given that i don't think any of you are physicians, would it be helpful if maybe there was

an insurer, don't know column that you could check as well? which if i'm an insurer, there which if i'm an insurer, there would be something that@@@@@@ i heard many people who formerly

work at insurance companies talk about these secret specific units that are designed to find errors or omissions or whatever you want to call them in people's records so that they can go back and save money. >> i think we actually get some of that testimony from our final witness from georgetown that says it may be a small percentage, but it's perhaps a big percentage of the claims cost. >> i'd just like to say, those are the people you know of. there are many people out there who lose their insurance and then go on medicaid, go on welfare, go without insurance. you're not aware of who those are. those are their numbers. those aren't the consumers' numbers. we don't really know how many people are out there. and you know what, i don't care if there is just the three of us, that's too many. one too many who dies because an insurance company canceled their insurance is one too many. >> all right. any final comments? i just wondered if you had any final comment on that point.

it's okay if you don't. >> i'm real hard of hearing. what did you say? >> i just wondered if you had any final comment. >> i just agree with what both of them said, and i know so many people in my cancer group that i wish could be here to talk to you that you wouldn't believe their stories. it's a common practice, and you'll never know how common it is, and when they hire nurses to investigate, their whole shift do nothing but review medical records looking for things to get rid of people. that just shows you right there. >> indeed. thank you very much. thank you, mr. chairman, for your indulgence. >> thank you. let me just ask a question. we focused on what happened to you three, as we should, rightfully so, but we found close to 20,000 cases where there were rescisions in the last three years from insurance companies who will testify in the next panel.

and there are even people like a spouse gets in a bicycle accident, has some fractured bones and then denied because her husband had back surgery. what bearing that had on that lady's fractures is beyond me. but that's what we're seeing. ms. beyton, one thing i want to ask you. in your testimony you stated, and i'm going to quote now, that you lived with fear every day with my insurance company. what are you afraid your insurance company might do? >> without a doubt, someday they'll cancel me. someday mr. barton won't be there to protect me. i'm young, and they'll find something to get rid of me. somehow i won't have insurance. someday i'll be out of blue cross and blue shield's record. they'll find some way to get rid of me, and coming here today would just about do it. >> so if you lost insurance, you think you wouldn't get insurance from another company since you've been rejected once?

>> if i lost insurance what? >> are you afraid you wouldn't be able to pick up another individual insurance company? >> i'm uninsurable. the only way i could do it is have a job and be part of a group. >> because of a preexisting condition? >> because i have cancer. once you have cancer, you're uninsurable forever. >> that will teach me to wear a light-colored suit. thank you, mr. chairman. i wanted to express my appreciation for the witnesses coming here today. certainly none of us condone abuses within the system, and you pointed out some of those that appear to be in that category, and i know it took a great deal of effort on your part to come, and we appreciate your courage and we appreciate your time that you've devoted to it. i do not have any questions of

you. i think your testimony speaks for itself. thank you, mr. chairman. >> well, that was pretty quick. any other -- greg? >> well, let me thank this panel for their testimony, their heartfelt testimony, and thank you for shedding some light on this. this is the face now like the callers that impalla witnesses. in a second panel we have don hamm, executive officer of assurant self, mr. collins, owned by united health group. mr. brian sassi, am i saying that right? sassi who is the president and

chief executive officer of wellpoint inc. and ms. karen pollitz who is the research professor georgetown university health policy institute. welcome to all of our witnesses. is the policy of the subcommittee to take your testimony under oath. please bid bison of the right and the rules of the house to be it buys the council during your testimony. kiewit to be represented by counsel during your testimony? mr. hamm you would? any time during the questions if you want to get advice from counsel, just let us know and we will allow the. council cannot testify but the cannon fisa. mr. collins? mr. sassi? ms. pollitz? so then let me have you raise your right hand and take the oath. do you swear or affirm the testimony you are about to give is the truth, the whole truth and nothing but the truth in the matter pending before this committee? let the record reflect that the witnesses replied in the

affirmative. they are now under the beginning with their opening statement. you have five minutes for an opening statement in you may submit a longer statement for inclusion in the record. mr. hamm if you don't mind will start with you, start from my left and go to the right. >> chairman stupack, congressman waldman, mears of the subcommittee i'm don hamm president and ceo of assurant health. welcome this opportunity to birds is a bait in the hearing today. is the dialogue like this that we can continue to address one of the most challenging issues of our time, providing health insurance coverage for all americans. we appreciate that this subcommittee in congress are committed to finding the right place to address healthcare reform. if the system can be created where coverage is available to everyone and all americans required to participate, the process we are addressing today, recision, becomes the necessary because risk is shared among all. i passionately believe that all americans must have access to high-quality, affordable

healthcare regardless of their income or their health status and i am proud to lead a great company that provides health coverage to individuals and families in 45 states. people need their products and we are proud to provide them to thousands of americans. individual medical insurance is affordable and belongs to each consumer and these uncertain economic times individual medical provides benefits to a growing population who do not receive a employee sponsored health coverage. that is why individual medical is so important. we work hard to ensure our health questions are simple, easy and straightforward kurds medical history is necessary so we can fairly assess the health risks of each applicant. the vast majority people complete the enrollment form accurately. the underwriting process depends on misinformation and we rely upon the consumers disclosures. people applying for an individual insurance are given multiple opportunities to verify

correct and complete the information they provide. they are given ten days to notify us of any inaccurate information or to reject the coverage. at assurant talf we are acutely aware of how our coverage affects people's lives. it is the responsibility we take very seriously. unfortunately there are times when we discover information that was not disclosed during the enrollment process. when this information is brought to our attention, we ask additional questions to determine if the information would have been material to the underwriting risk we assume. ackeridge risk assessment keeps rates lower for all. assurant health this not want to rescind coverage. we are in fact in the business of providing healthcare coverage. we regret the necessity of even a single recision. the decision is never easy and that is why we follow a fair and thorough process that includes a number of careful review is. here is our system works.

when we become aware of the condition that exists that prior to the application date and that information was not disclosed, a senior underwriter reduce the admitted information to determine if it was material to the underwriting decision. then the underwriting management verifies the analysis. fig mission was not material to the review is complete. if the omission was material the underwriter makes a recommendation to a review panel which includes a least one physician. this review panel evaluates information and makes the decision. the amount of the potential claim is never disclosed to the underwriters or to the review panel. the decision to resendiz only made when the undisclosed information would have made a material difference to the underwriting decision based on our guidelines. the consumer is given the opportunity to provide additional information before coverage is rescinded. this information is evaluated and a decision is made.

if the consumer isn't dissatisfied with the decision we provide multiple opportunities to appeal, which now includes an option to request the medical read you by an independent third party company. precision affects less than one-half of 1% of the people we cover yet, it is one of many necessary protections for affordability and viability of the individual health insurance in the united states. assurant hell supports the principle that everyone in the united states deserts affordable healthcare and we see reform of the nation's healthcare system as a shared responsibility between doctors, consumers, health insurance and policymakers. the collectively can deliver effective solutions to provide coverage for all americans. that is why assurant health we will continue to participate in efforts to reform and improve healthcare in america. thank you. >> thank you mr. hamm.

mr. collins, your opening statement please sir. >> good morning members of the subcommittee, thank you for inviting me to testify today. my name is richard collins, i and the ceo of golden rule insurance company. we are business that sells health insurance policies to individuals and their families. colgan roose the offering this at coverage for over 60 years. we seek to offer innovative and affordable products to meet the diverts healthcare and financial needs of our customers. in our current healthcare delivery system, the individual insurance market operates primarily for families who do not have access to group insurance or government benefit programs. we have long advocated that our country needs comprehensive reform that includes modernizing our delivery system, tecla in the fundamental drivers of healthcare costs rath, strengthening employer-based coverage and providing well

targeted support for low-income families. to be effective, to be effective we believe the modernization of the individual market these contain all of the following elements. first of all, individuals must be required to obtain or maintain health coverage so that everyone who participates in both the benefits and the cost of the system. second, ensure should be able to set rates within limited parameters of age, geography, family size and benefit design just as they do in the group market. however i want to emphasize this point. rates should not carry on health status and coverage should be guaranteed, regardless of preexisting medical conditions for those that maintain continuous coverage. there, though and middle income families should receive some form of subsidy to ensure they have the same access to care as

all americans for gofourth, insurers should be able to offer a wide spectrum of plan designed to allow american families the flexibility to choose a plan that fits their budget and lastly, the treatment of individual insurance premiums should be on par with employer coverage. until a comprehensive reform is a cheap we believe the medical underwriting of individual policies will continue being necessary. if these changes are instituted, most of the reason for individual medical underwriting as well as most of the reasons for rescissions and terminations of policies would cease to exist. our company mission is to improve the health and well-being of all americans. in the individual market with accomplices by covering as many consumers as possible with quality health insurance. we also work to keep our products affordable to accomplish our mission because the primary barrier to access is affordability. we understand that we have a