Health Insurers Agree to Cover Children with Pre-Existing Conditions

Published: Wed 31 Mar 2010

Perry Begay

After almost a year fighting President Obama and Democrats in Congress over health care reform, health insurers have agreed not to impede the administration's attempts to remedy a potentially embarrassing mistake in the new law.

In a letter addressed to Secretary Kathleen Sebelius of the Health and Human Services Department, the health insurance industry's ranking lobbyist announced Monday that health insurers will agree to new regulations to eradicate uncertainty about a very publicized guarantee that children with preexisting conditions can get medical coverage starting this year.

The prompt resolution of the uncertainty was a victory for President Obama, and a signal that the health insurance industry does not have the strength for another battle with a president who so cunningly used double-digit premium increases by insurers to breathe new life into his foundering health care legislation in Congress.

"Health plans recognize the significant hardship that a family faces when they are unable to obtain coverage for a child with a pre-existing condition," said Karen Ignagni, president of America's Health Insurance Plans, in a letter to Secretary Sebelius. Ignagni claimed that the health insurance industry will "fully comply" with the new fixes, expected in the next few weeks.

Additional Objections

Health insurers still have many other objections to the health care reform law, including beliefs that it will increase premiums and doubts that it will accomplish its stated purpose of providing medical coverage to 95 percent of eligible Americans.

With regard to children's coverage, however, there will be no bickering. Ignagni's letter to the Obama administration came after a strongly worded letter from Secretary Sebelius to the health insurance industry sent earlier the same day. Sebelius, the administration's ranking health care official, attempted to put to rest questions about the law's verbiage and purpose.

"Health insurance reform is designed to prevent any child from being denied coverage because he or she has a pre-existing condition," wrote Sebelius to Ignagni. "Now is not the time to search for nonexistent loopholes that preserve a broken system."

Sebelius stipulated that a child with a preexisting condition cannot be denied access to his/her parents' coverage under the new legislation. Additionally, insurers will be unable to provide coverage to a child while excluding treatments for a specific 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. The new revisions will be available beginning in September, she said.

Consequences of the Fine Print

The law's fine print was not clear on whether children with preexisting conditions were guaranteed medical coverage beginning this year, as Obama had claimed repeatedly while touting the bill that he signed last week.

If the issue had continued, certain parents and their kids may have had to wait for coverage for a long time. The law's sweeping ban on the denial of coverage to anyone on the basis of a health condition does not take effect until 2014.

The glitch with the issue of covering children was that the law may also be interpreted in a narrower way.

Indeed, Senate and House staff members on two committees that authored the law conceded last week that the legislation stopped short of an absolute guarantee. Later, House officials issued a statement explaining that their intent in authoring the legislation was to offer full protection.