Obama adminstration moves to fix kids coverage gap
WASHINGTON DC
It remained unclear if the sternly worded letter from Health and
Human Services Secretary Kathleen Sebelius would settle a dispute
over a widely touted achievement of the health care law that Obama
signed last week.
The fine print of the law appears to have been less than
completely clear on whether kids with health problems are
guaranteed coverage starting this year. If there's a problem, some
parents and their children may have to wait a long time: The
legislation's broad ban on denying coverage to any person on
account of a health condition doesn't take effect until 2014.
The sticking point is that the immediate benefit for children
may not be as sweeping as Obama has claimed in extolling the
legislation.
That's because the law can also be read to mean that if an
insurance company accepts a particular child, it cannot write a
policy for a child that excludes coverage for a given condition.
For example, if the child has asthma, the insurer cannot exclude
inhalers and respiratory care from coverage, as sometimes happens
now.
But the company could still turn down the child altogether.
"The industry seems to be saying, 'You didn't write it the way
you meant it'; the government is saying, 'Yes, we did,' " said
health policy consultant Robert Laszewski, a former insurance
executive. "Now we need to see what the industry does. Is the
industry going to fight this? It would create some real public
relations problems."
In a letter to the main industry trade group, Sebelius attempted
to remove any doubt.
"Health insurance reform is designed to prevent any child from
being denied coverage because he or she has a pre-existing
condition," she wrote America's Health Insurance Plans. "Now is
not the time to search for nonexistent loopholes that preserve a
broken system."
Sebelius specified that children with a pre-existing medical
problem may not be denied access to their parents' coverage under
the new law. Furthermore, insurers will not be able to insure a
child but exclude treatments for a particular medical problem.
"The term 'pre-existing condition exclusion' applies to both a
child's access to a plan and his or her benefits once he or she is
in the plan," Sebelius wrote, adding that her department will
shortly issue a regulation to that effect. The new protections will
be available starting in September, she said.
There was no immediate public response from the industry group.
Obama has conveyed the impression that the law provides ironclad
protection.
"Starting this year, insurance companies will be banned forever
from denying coverage to children with pre-existing conditions,"
the president said in a recent speech at George Mason University in
Virginia.
But House and Senate staffers on two committees that wrote the
legislation said it stopped short of a full guarantee. House
leaders later issued a statement saying their intent was to broadly
require coverage for kids with medical problems.