9/11 Illness No Longer Bar to Insurance Coverage Under Affordable Care Act

In a 2006 New York Times article, the co-director of Mount Sinai’s World Trade Center Worker and Volunteer Medical Screening Program, Dr. Robin Herbert, stressed the lifelong health consequences faced by ground zero workers:

”There should no longer be any doubt about the health effects of the World Trade Center disaster . . . Our patients are sick, and they will need ongoing care for the rest of their lives.”

She also made the disturbing observation that 40 percent of the patients who came to the hospital for screening had no health insurance.

Without insurance, many first responders, residents and workers who survived the terrorist attacks had trouble getting treatment for their 9/11-related illnesses. Initially, skepticism about whether certain illnesses were caused by toxic exposure on 9/11 further thwarted the efforts to finance treatment. Fortunately, the truth finally prevailed and the Victim Compensation Fund (VCF) added some of the illnesses previously deemed unrelated, including certain types of cancers.

However, individuals without health insurance at the time of the 9/11 attacks encountered the real prospect of never again qualifying for health insurance. Pre-existing condition clauses in most insurance policies made them ineligible for insurance coverage, a common practice that was totally legal in the years following 9/11. If an illness was not covered by the VCF and yet was considered pre-existing, the patient had little recourse for treatment. 

The Affordable Care Act (ACA) rectifies coverage issues related to 9/11 diseases by:

• Prohibiting denial of coverage for children with pre-existing conditions since 2010
• Prohibiting denial of coverage or policy renewal for all people with pre-existing conditions since 2014
• Eliminating the practice of imposing lifetime limits on essential benefits
• Eliminating annual limits on treatment
• Prohibiting gender discrimination, which previously subjected women to higher rates
• Ensuring coverage for clinical trial participation, which may provide treatment options for 9/11 victims with rare cancers and other diseases
• Expanding eligibility for and access to Medicaid (in New York and select states)

To learn more about your rights to post-9/11 insurance coverage, consult with Barasch & McGarry in New York City.