Will Health Care Reform Help Sick Children? Maybe Not.

BlogHer Original Post

As history shows us, any major political change will meet with resistance. Although health care reform was signed into law days ago, insurance industry insiders (such as industry attorney, William G. Schiffbauer, quoted below) are floating the claim that they do not have to issue policies covering some children with pre-existing conditions despite President Obama's claim that this year the legislation would permanently end this form of denial of coverage.

Sick Child

Robert Pear reports in the New York Times:

William G. Schiffbauer, a lawyer whose clients include employers and insurance companies, said: "The fine print differs from the larger political message. If a company sells insurance, it will have to cover pre-existing conditions for children covered by the policy. But it does not have to sell to somebody with a pre-existing condition. And the insurer could increase premiums to cover the additional cost."

Phil Galewitz and Andrew Villegas of Kaiser Health News report: "One thing is clear: The law does nothing to stop insurers from charging higher rates for children with pre-existing illnesses until 2014 when insurers can no longer use health status in setting premiums." They also note that "Randy Kammer, a vice president for Blue Cross and Blue Shield of Florida, the largest health insurer in that state, said she interprets the law as allowing insurers to reject coverage for children in some cases until 2014."

Under the just-signed law, those practices will end for adults and children both in 2014. However, hopes have been put on hold for parents of children with a range of illnesses, who have to purchase coverage in the individual market and thought they would now have access to affordable plans.

The White House indicates that President Obama's administration believes that the law does require access to health insurance for children with pre-existing conditions. However, some observers -- such as Sandy Praeger, the insurance commissioner of Kansas, quoted in the New York Times article, and David Dayen of FireDogLake -- believe that efforts to clarify the administration's interpretation through issuing regulations will not be sufficient, and that the legislation will have to be amended to ensure implementation before 2014:

"I would like to see the kids covered," said Sandy Praeger, the insurance commissioner of Kansas. "But without guaranteed issue of insurance, I am not sure companies will be required to take children under 19."

Some conservative and industry opponents of the health care reform legislation see this as evidence of why the law is flawed and should be repealed. Other liberal critics see this as a case for why single-payer health care coverage should be enacted instead.

What's your take? Is this evidence that trying to allow the government to dictate how businesses should operate is doomed to failure? Totally expected push-back in the face of big change and will be handled through clarification and further refinement of the new law? A wake-up call to continue to push for a single payer, Medicare-for-all alternative to for-profit health insurance?

More Voices

Karoli at Crooks And Liars: Insurance companies, what part of "No pre-existing conditions exclusions for kids" don't you understand?

With legislation this broad, there will always be areas where either a technical correction is needed or a regulation. It's likely that a regulation will suffice to create the clear bridge from no exclusions to guaranteed issue. Frankly, if insurers think it's a good idea to continue to thumb their collective noses at the Congress and President of the United States by either creating or inventing loopholes, they're likely to find themselves without any leverage and little voice in what their future regulatory environment will look like....

Update 4:10pm HHS Secretary Kathleen Sibelius confirms that regulations will require all insurers to cover children AND issue new policies to children regardless of pre-existing conditions.

AlphaPatriot: Coverage for Sick Kids? Not So Fast!

With over 900 pages of legalese neatly divided into parts and subparts, sections and subsections, titles and subtitles, you’d think the Social Democrats would be able to achieve one of the mainstays of their objective. Then again, if they were that smart they wouldn’t have saddled an ailing economy with Obamacare in the first place.

Tony Ondrusek at Insurance & Financial Advisor IFAwebnews.com: Issue of coverage for sick kids unclear in Obama health reform law

While no one can argue that covering children with pre-existing conditions is one of the fundamental cornerstones of any health reform legislation, perhaps Congress and the president would have been well-advised to follow the will of the American people. Citizens wanted — and according to the polls still want — its lawmakers to take the time to craft individual bills that would build upon each other, instead of the quagmire that we now find ourselves in. Spending months and years attempting to dissect and digest the nearly 3,000 pages of this law will find us debating singular issues such as this.

Meanwhile, the American people won’t get what they want and deserve: Health care reform that is specific, clear and with few hurdles to implementation.

Cheree Cleghorn at The Patient Report: Health Plans Balking on Coverage for Pre-existing Conditions for Kids ... New Health Care Reform Law Does Not Apply Now, Plans Say

This resistance represents plans’ views of what is best for their bottom lines.

They could hardly have handed fans of a single payer plan a better weapon to use to question their standards and practices.

Francine Hardaway at Stealth Mode: Unintended Consequences

How can a society that doesn't even care about its own children continue to survive?

desmoinesdem at Mother Talkers: Loophole in health reform bill affects kids with pre-existing conditions

Melissa McEwan at Shakesville: Not Even Healthcare Reform

BlogHer Contributing Editor Maria Niles also occasionally blogs politics and policy at PopConsumer