"What am I going to do?" Joshua wondered. Her 2-year-old daughter, Jasmine Winning, needs heart surgery next year because of a rare disease she's had since birth. The toddler has had two heart operations already because she was born with a malformed heart — a condition resulting from Heterotaxy syndrome, in which internal organs are not where they should be.
Joshua believes it's critical to keep the same doctors for her daughter because they know her unique anatomy. Disrupting the relationship between Jasmine and her medical team would be a "threat to her life," the girl's mother said.
Cigna's decision, along with the recent news that Anthem Blue Cross will pull out of the individual market across a large swath of California, has prompted a key state lawmaker to propose legislation that would help seriously ill patients like Jasmine keep their doctors even if those doctors don't contract with the new health plan.
Anthem cited market instability, tied to uncertainty about federal policy, as a principal reason for pulling out. Cigna also cited instability. State Sen. Ed Hernandez (D-West Covina) said the new bill, which he introduced, would protect vulnerable patients from being harmed by it.
"We have to make sure there's stability and some calm [for] the consumer," said Hernandez, chairman of the Senate Health Committee.
For people who buy their own insurance and have to switch plans because their insurer is pulling up stakes, the Hernandez bill would require the new plan to cover treatment by the same physicians, even if they are not in the new insurer's network.
The provision would apply for enrollees under treatment for a chronic, acute or terminal illness, and in cases of pregnancy. The coverage would be contingent on the doctor accepting the payment offered by the new health plan, and the insurer would have to continue covering the services of that provider for up to one year. The coverage could extend beyond a year if the patient were terminally ill.