Paper short abstract:

Twenty years ago, the Brazilian government redefined the responsibilities of private health insurers. Faced with these laws, health insurers have come up with several ‘solutions’. This paper explores how these solutions pivot around contested responsibilities and definitions of personhood.

Paper long abstract:

Twenty years ago, the Brazilian government redefined the responsibilities that private health insurance providers have towards their clients. New laws and government institutions had to offer better protection against a powerful insurance sector. These laws regulated, among others, premium increases, limited exclusionary clauses, as well as the unilateral cancellation of health insurance policies. Actuaries and other professionals working in the insurance sector argue that these laws are not logical, contradictory, immoral, and therefore undermine the economic principles on which health insurance is premised. Health insurers have come up with several ‘solutions’ that redefine their responsibilities. These solutions, some of them illegal, pivot around a redefinition of personhood, that legally redefines the individual as a collective enterprise. This paper explores the role that personhood plays in the configuration of responsibility. It is based on extensive and ongoing fieldwork among health insurance clients and their family members; interviews with actuaries and other professionals in the health insurance sector; and the analysis of lawsuits against health insurers.