Ethics

It was four years ago today that I received a phone call from a Los Angeles TV reporter that would change my life, although I certainly didn't realize it at the time.

The reporter said she had been told that CIGNA, the big health insurer I worked for back then, was refusing to pay for a liver transplant for a 17-year-old girl, even though her doctors at UCLA believed it would save her life and her family's policy covered transplants.

I didn't pay much attention to the call at first, because as chief spokesman for the company, I had received many calls over the years from reporters seeking comment about benefit denials. We took them seriously, but usually didn't have to do more than tell the inquiring reporters we couldn't comment substantively because of patient confidentiality restrictions. If pressed, we'd email a statement to the reporter briefly noting that we covered procedures deemed medically necessary and that patients and their doctors could appeal a denial if they disagreed with a coverage decision.

The money that patients' rights advocates have to spend trying to convince the Obama administration that Americans should have decent health care benefits pales in comparison to the boatloads of cash insurers and their corporate allies have on hand to do largely the opposite. But at least the advocates are now in the game.

Last week a broad coalition of patient-focused groups launched its "I Am Essential" campaign in an effort to make sure that when all of us have to buy health insurance in 2014, we will be getting good value.

The Obama Administration will be making some important decisions over the coming weeks that will determine to a large extent whether consumers or health insurers will be the biggest beneficiaries of health care reform.

When Congress passed the Affordable Care Act last year, it included a controversial provision that insurers insisted on, but which is undoubtedly the most unpopular part of the law: a requirement that all Americans not eligible for a public program like Medicare or Medicaid must buy coverage from a private insurance company.

To make that mandate fairer and more palatable, Congress also included provisions that eventually will make several of the insurance industry's most egregious practices illegal, such as refusing to sell coverage to people just because they have a pre-existing condition. The law also prohibits insurers from selling "junk" insurance and from cancelling policyholders' coverage at the time they need it most -- when they get sick.