Abstract
"MILLIONS OF hardworking, honest Americans are being held hostage by insurance companies. I am one of them." So begins a letter to President George Bush from Mary Evans, a Columbus, Ohio, woman with an increasingly common tale to tell: Savings wiped out after payment denials for treatment of preexisting conditions (in Evans' case, surgery to remove breast cancer that her insurer says she "should have" found before she had to switch policies because of her husband's job change); Fear that recurrence would require a bone marrow transplant she could not afford if her insurance would not pay; Disgust with what Evans calls the "mountain of paperwork" and "snippy, haughty, surly" treatment from insurance companies; No apparent way out. If she dared to change insurers, a new policy would almost surely exclude cancer coverage. "If you have the misfortune of getting a catastrophic illness, you are literally held hostage by the

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