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Jane Ahlin, Published September 27 2009

Ahlin: Insurance attitudes in ND have changed since 1995

Let’s say that a North Dakota couple named Barbara and Bill have a fight, and he slaps her around. Her face is bruised, and she fears her wrist is broken. She goes to the emergency room, the police are notified, and they arrest Bill, who expresses great remorse. Although he spends the night in jail, sometime later he is allowed to plead guilty to a misdemeanor charge of simple assault. End of story.

Well, not quite. Let’s say Barbara and Bill split up after the incident but months later each seeks individual health care insurance. Which one legally can be denied coverage in the state of North Dakota?

Did you guess Barbara?

In North Dakota it is lawful for a victim of domestic abuse to be denied health insurance. According to a recent report by the Service Employees International Union – which was based on a study done in 2008 by the National Women’s Law Center as part of a larger project on health reform – North Dakota is one of eight states that does not prohibit insurance companies from using domestic violence as grounds for denying individual health insurance coverage.

Appalling as that is, there’s good news. Well, more correctly, there’s good news and bad news. The good news: Although legal, there’s no evidence North Dakota insurance companies actually have used domestic abuse as a so-called “pre-existing condition.” The bad news: In 1995, when a bill was presented that would have prohibited the denial of health insurance to victims of domestic violence – a time when most other states were responding to a national push to get the prohibition into state codes – the North Dakota House resoundingly defeated the bill, 67 to 29.

At that time, Lisa Weinman, legal counsel, North Dakota Insurance Department, gave written testimony in favor of the bill, as did Rosellen Sand, general counsel, North Dakota Attorney General’s Office. Farmers Union Insurance took a neutral stand on the bill, but Blue Cross Blue Shield opposed it. (Really, given the recent woes of the Blues, nobody wants to pile on, but the new CEO has his work cut out for him.)

While those opposed to the bill cited the lack of evidence of insurance denial to domestic violence victims – in other words, no need to fix what’s not broken – proponents of the bill cited the need for the state to send a clear message to the perpetrators that all parts of the community, including the insurance industry, would not tolerate domestic violence. More importantly, the message to the victims would be unmistakable: When they sought help, the people of North Dakota would stand with them.

What the Legislature ignored in 1995 was testimony to the complicated “dynamics of abusive relationships” that keep women from seeking help and getting started on the road to independence (in 1994, all five murders in North Dakota were attributed to domestic violence). They did not “get” the moral and ethical dimensions of the legislation they voted against. To them, a legal prohibition for insurance denial on the basis of domestic violence was unnecessary interference in the business of health insurance. And some of the industry saw it the same way.

Not today. Insurance Commissioner Adam Hamm has expressed surprise that the Legislature left the state open to such an offensive loophole and vows to correct it. There is a chance that won’t be necessary. In the national health care reform discussion, both political parties have awakened to the unethical nature of denying insurance on the basis of pre-existing conditions. If reform passes, pre-existing conditions will be an insurance relic. And it’s about time.


Ahlin is a regular contributor to The Forum’s commentary pages.