JANE BRYANT QUINN
The widely touted Health Insurance Portability and Accountability Act (HIPAA), passed by the Congress in 1996, isn't delivering as promised at least not for everyone.
Generally speaking, HIPAA guarantees you access to new health insurance if you've been in a group plan and lose your job.
Healthy people don't need this law. It's for workers and their families who are dealing with a chronic illness or serious disease. Without HIPAA, insurers might exclude them from coverage.
The new health plan you switch to isn't forced to cover your particular disease, but it can't exclude you while providing that coverage to everyone else.
Most Americans came under HIPAA by last January. Some weren't covered until this month. Starting this month everyone is finally covered. A handful of states already had guaranteed-coverage laws of their own. HIPAA has worked best for job switchers who move from one health plan to another.
"It's now easier to join the new health plan without facing unreasonable exclusions or waiting periods," says Sen. Edward Kennedy, D-Mass., one of the sponsors of the law.
Easy, that is, if you join the new plan within 30 days of becoming eligible. If you don't, and then change your mind, some insurers will require you to wait 18 months for coverage. HIPAA allows this, although some states may not.
Workers with an illness in the family face even higher hurdles when they leave an employee group plan and have to buy an individual policy. This occurs when your new employer has no health plan or if you start working for yourself.
In many states, high-risk individuals including people eligible for HIPAA are diverted into special insurance pools. In others, insurance companies sell HIPAA policies directly.
Some insurers who sell directly haven't been living up to the law. That might have been temporary while insurers learned the rules, says Randy DiRosa, a senior evaluator for the Government Accounting Office in Chicago.
Or it could have been deliberate. Here are the kinds of problems that have been reported:
? Insurers may delay your application, or take a long time to issue a price quote. If 62 days pass from the time you leave your group plan, you no longer qualify for guaranteed coverage under HIPAA. (You still qualify, however, in 13 states that mandate coverage for everyone. Ask your insurance agent about it.)
? Insurers may pay agents much lower commissions for HIPAA policies, which discourages the agents from making sales. Take Central Reserve Life Insurance Co. in Strongsville, Ohio. Since Jan. 1, it has paid a commission of only 4 percent on HIPAA plans sold to individuals. That compares with 20 percent commissions on policies sold to healthy people. Central Reserve's president, Glen Laffoon, says commissions were cut only to keep the price of HIPAA policies down.
? Insurers may charge prices so high that you can't afford to buy. Some policies cost 500 percent more than the normal rate, says Missouri Insurance Director Jay Angoff and the normal rate is bad enough.
HIPAA allows health insurers to charge what they want, even if it prices people out of their so-called "guaranteed" coverage. This part of the law was always a joke.
It's illegal, however, to deliberately delay your application. President Clinton recently warned that insurers who violate HIPAA would not be allowed to participate in the federal health-insurance plan.
In practice, insurers haven't actually been thrown out of the plan. Problems have been solved through bilateral negotiations, says a source at the federal Office of Personnel Management in Washington, D.C.
Here's who's eligible for HIPAA protection:
? Applicants for individual health insurance, if they're leaving a group-health plan that covered them for at least 18 months. If your former company employed 20 people or more, you can keep its group plan, at your expense, for at least 18 months. You must use up this coverage before HIPAA applies.
? Applicants for new group plans, if they belonged to their previous group plan for at least 12 months. If you belonged for less than 12 months, the new plan can impose a waiting period before covering pre-existing illnesses but in any case, no more than 12 months (18 months, if you don't join the new group right away).
Is your spouse a secret tax cheater? Formerly, the IRS could come after you, if your spouse underreported his taxes on your marital return. When you file jointly, you are normally liable for all the taxes due.
A new law, however, rescues certain spouses who innocently signed a bad return. You qualify for protection if you're divorced, widowed or legally separated, or have lived apart from your spouse for the past 12 months.
Spouses on their own are responsible only for the taxes due on their individual incomes. You don't owe the tax that your spouse attempted to evade.
You'll need an accountant to help you divide the income and deductions. Assuming that you reported all your income, your share of the tax has already been paid. To collect any more, the IRS is going to have to snare your spouse.
To get this protection, by the way, you really have to be innocent. You can't have known about the item that was false.
The new law also helps innocent spouses in community property states. Formerly, you could be liable for the unpaid tax on returns that your spouse filed separately. Now, the IRS can let you go.
But the law still discriminates against an innocent spouse who stays married, in any state. You can apply to have your personal income and property protected from seizure, but the IRS has a lot of leeway to say no.
Be warned: No spouse married, separated or divorced will be helped automatically. You will have to file a special IRS innocent spouse form, which should be ready within 180 days.
Syndicated columnist Jane Bryant Quinn can be reached in care of the Washington Post Writers Group, 1150 15th St., Washington D.C. 20071-9200.
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