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From www.bluemoonbenefits.com Guaranteed-Issue Coverage for Children with Preexisting Conditions
When you draft 2,700+ pages of health reform legislation, give members of Congress and the American public barely 72 hours to read the provisions, and allow for limited amendments to the measures throughout the process, there are bound to be mistakes. One of the first drafting errors in the new health reform legislation that came to light this past week concerns the coverage of preexisting conditions in children. President Obama campaigned on this issue, and he and his administration have repeatedly touted eliminating the ability to deny coverage to children with preexisting conditions, and requiring the coverage of such conditions with no look-back or exclusionary periods, as one of the first benefits of the new reform laws. The President and congressional Democrats have repeatedly cited these provisions as benefits that will help American children within the next six months. A small problem, though—the new laws don’t actually say that. The new measures do require health plans serving all markets—individual, small and large-group and self-funded—to cover the preexisting conditions in children age 19 and under with no limitations if the coverage is already offered or in force for all plan years beginning on or after six months of the March 23, 2010, enactment date. However, the new laws do not require insurers in all markets to guarantee-issue coverage to anyone at any age until plan years beginning on or after January 1, 2014. That means for the markets where health insurance coverage is not guaranteed issue under existing federal or state law (the individual market in most states and technically the large-group market), insurers could choose to not offer coverage in the first place to a child with a preexisting medical condition.  Once this mistake came to light, the Obama administration immediately responded that it was the intent of the legislation to both offer these children access to coverage and provide for that coverage without regard to preexisting condition. Federal Department of Health and Human Services Secretary Kathleen Sebelius wrote a letter to Karen Ignagni, president and chief executive officer of America’s Health Insurance Plans (AHIP), blaming insurers for potentially failing to offer such affected children coverage, and indicating the administration’s plan to correct the problem in the new laws via federal regulation: “Unfortunately, recent media accounts indicate that some insurance companies may be seeking to avoid or ignore a provision in the new law that prohibits insurance companies from excluding children with preexisting conditions from coverage.   “To ensure that there is no ambiguity on this point, I am preparing to issue regulations in the weeks ahead ensuring that the term ‘preexisting condition exclusion’ applies to both a child’s access to a plan and to his or her benefits once he or she is in the plan. These regulations will further confirm that beginning in September 2010: Children with preexisting conditions may not be denied access to their parents’ health insurance plan; Insurance companies will no longer be allowed to insure a child, but exclude treatments for that child’s pre-existing condition.   I urge you to share this information with your members and to help ensure they cease any attempt to deny coverage to some of the youngest and most vulnerable Americans.” AHIP President Karen Ignagni quickly sent back a response indicating that “With respect to the provisions related to coverage for children, we await and will fully comply with regulations consistent with the principles described in your letter.”

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