Health benefits

Just recently, Pasig City Rep. Roman Romulo filed a bill that would penalize private health-maintenance organizations (HMOs) that discriminate against the country’s more than six million senior citizens.

House Bill 6348, the proposed Anti-Healthcare Age Discrimination Act, mandates the Insurance Commission to impose administrative fines of up to P300,000 on HMOs that refuse to sign up individuals who are 60 years old and above.

The bill also entitles every senior citizen to moral and exemplary damages in the event he or she is denied HMO coverage.

According to Romulo, several HMOs unjustly impose an age ceiling that automatically disqualifies individuals who are 60 years old and above. Other HMOs just refuse to renew the coverage of planholders when they reach 60 years old.

Romulo said this constitutes strong age discrimination, which is totally unfair and simply unacceptable.

The lawmaker invoked Section 11, Article 13 of the Constitution, which mandates the State to make essential healthcare services available to all, especially the elderly, at an affordable cost.

He stressed the State and the private sector have a shared duty to improve the welfare of senior citizens.

HMOs provide prepaid health insurance plans to enrolled members through a network of contracted hospitals and doctors. There are 23 HMOs doing business in the country, and together they now have more than four million planholders, Romulo revealed.

Last November, President Aquino issued Executive Order 192 which transferred the supervision and regulation of HMOs to the IC from the Department of Health.

 Romulo said access to HMO plans and services would augment the healthcare benefits that senior citizens now enjoy under the law, including the 20-percent discount on hospital charges and the cost of medicines, and automatic coverage by the state-run Philippine Health Insurance Corp.

The worst that can happen to any Filipino is to be old and poor.

But being poor in terms of being able to afford healthcare in the Philippines takes on a whole new meaning.

Illnesses such as cancer, heart-related ailments, kidney and liver diseases are literally for the rich.

An article by Rappler (http://www.rappler.com/thought-leaders/98624-who-are-middle-class) mentioned that “a household of five persons would be considered middle class if its total monthly family income in 2012 ranged from about four times the government’s official poverty line, i.e., about P30,000 (P31,580) to 10 times the poverty line, i.e. nearly P80,000 (P78,895).” There are about 3.6 million households in this class, it said.

The same article also cited the different income classes, their range of monthly family incomes, and size of class or number of households as follows: poor or those with per capita income of less than the official poverty threshold (less than P7,890 per month, 4.2 million households); low income, but not poor or those with per capita incomes between the poverty line and twice the poverty line (between P7,890 and P15,780 per month, 7.1 million households); lower middle income or those with incomes twice the poverty line and four times the poverty line (between P15,780 and P31,560 per month, 5.8 million); middle class (mentioned in the preceding paragraph); upper middle income or those with per capita incomes between 10x the poverty line and 15x the poverty line (between P78,900 to P118,350 per month, 470,000 households); upper income, but not rich (between P118,350 to P157,800, 170,000 households); and rich (at least P157,800, 150,000 households).

The article, unfortunately, does not discuss the impact of taxation (the Philippines has the highest tax rates in the region, penalizing the middle class the most) and inflation. In reality, Filipinos have little to spend for their daily needs, more so for non-essentials like health insurance and bank savings?

I have two health cards (one issued by an HMO and the other by an insurance company). I pay for one, though at a slightly subsidized rate because it is under a company plan. The other is free. But not one can help pay for the cost of an angioplasty in case I end up needing one (I heard the cost depends on the number of stents that will be inserted, but easily one will have to shell out around P300,000 at least).

I know how it is not to have an HMO card and incurring all those medical expenses, not knowing where to source funds to pay for medical bills. My point is that even with existing HMO coverage, being sick is still unaffordable.

My mom does not qualify as my dependent because she is over 70 years old. She has to be a principal member. Unfortunately, I cannot find an HMO that will accept her as a member, even if I am willing to pay for a much higher premium. They just do not accept those who are more than 60 years old. Even insurance companies do not have health insurance plans for senior citizens (kindly e-mail me if you know of one). Maybe there are, but I am pretty sure the rates are exorbitant.

As a professor of insurance law, I know where these HMOs and insurance companies come from. They have to balance risks and the amount of premiums that they are willing to accept from the planholder in exchange for taking on that risks. These are businesses and therefore have to make sure the risks they are taking on are calculated risks (remember those pre-need plans that had to close down because the traditional educational plans they offered did not take into consideration the risk that private school tuition fees will increase).

They will not take on the risk of accepting senior citizens as members, most of who already have pre-existing illnesses and will most likely need medical attention and therefore will surely be covered, if we leave it up to these HMOs and insurance companies offering health insurance.

The state, as parens patriae or parent of the nation (referring to the public policy power of the government to take care of those citizens who are unable to protect themselves), should step in and require senior citizen coverage by HMOs at affordable premiums. Maybe, these HMOs can be given benefits for doing this, say in terms of tax benefits. Or maybe, government can simply assert its police power to require senior citizen coverage.

All of us will become senior citizens. Government should take care of those who simply cannot afford HMO coverage. As for those who can or who want to or whose employers provide for one, government should also step in and make sure everyone can avail of it at affordable premiums.

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