Insurers Will Cover Children

WASHINGTON--The health insurance industry has agreed to comply with a provision of the health care reform law requiring them to provide insurance to children with pre-existing medical conditions within 6 months.

The industry is doing so even though some of its lawyers dispute the scope of the provision in the law as interpreted by Congress and the administration.

Health insurers' view--supported by the National Association of Insurance Commissioners as well as healthcare lawyers and consultants--is that the provision mandating that insurers allow parents to buy coverage for children with preexisting conditions doesn't kick in under the law until 2014.

In fact, the chairmen of the 3 House committees voiced indignation that the healthcare industry would resort to "ambiguities in the legislation" in an effort not to comply with congressional intent.

The statement from the committee chairman said they had also been reassured that the problem could be addressed through regulation.

In a letter to Kathleen Sebelius, secretary of the Department of Health and Human Services, America's Health Insurance Plans said in a letter dated March 29 that it will comply with the administration's interpretation of the provision.

"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, AHIP president and CEO. "That is why health plans in 2008 proposed reforms to make pre-existing condition exclusions a thing of the past."

She added that the industry awaits and intends to comply with regulations consistent with the principles described in a letter sent by Sebelius to Ignagni.

AHIP's position is that "the legislation that was enacted prohibits pre-existing condition exclusions for children starting in 6 months, and requires guaranteed coverage for children and adults starting in 2014," according to Robert Zirkelbach, its spokesman.

That is also the view of Sandy Praeger, Kansas insurance commissioner and chairman of the NAIC's healthcare task force.

"In looking at the bill, our experts were concerned there's no 'guaranteed issue' until 2014," Praeger said. "'Guaranteed issue' means when you're out buying insurance, they have to offer coverage to anybody who wants to buy in- here's nothing about how much they can charge, but they have to offer it."

Praeger added that while Congress intended to require guaranteed issue, "the bill's not written that way."

The provision included in the bill passed by Congress was included in legislation introduced in March 2009 by Rep. Allyson Schwartz, D-Pa.

In comments to the National Underwriter, Tali Israeli, Schwartz's press aide, contended that "guaranteed issue" is what the provision says, but in any event, Schwartz is pleased that the health industry has agreed to comply with the law."

Schwartz's view of the legislation intent was backed by Rep. Henry Waxman, D-Calif., chairman of the House Energy and Commerce Committee; Rep. Sander Levin, D-Mich., chairman of the House Ways and Means Committee; and Rep. George Miller, D-Calif., chairman of the House Education and Labor Committee.

"Under the legislation that Congress passed and the President signed March 23, plans that include coverage of children cannot deny coverage to a child based upon a pre-existing condition," they said in a statement.

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