Insurers say ‘No, we won’t’ (cover sick children)

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Boy, that was fast. The ink was hardly dry on the health reform law
when the insurance industry started saying that no matter what Congress
thought it passed and no matter what President Obama said, they didn’t
have to let sick children have health coverage
right away. As today’s story in the New York Times shows, the insurance
industry just can’t stop manipulating the fine print and denying care
to boost profit, no matter who suffers.

The only good news here is that, as with all big legislation, any
ambiguities in the language of the reform law are likely to be cleared
up in regulation, something White House spokesman Robert Gibbs emphasized in a briefing last week:  "To ensure that there is no ambiguity on this, the Secretary of Health
and Human Services, Kathleen Sebelius, is preparing to issue
regulations next month making sure that the term ‘preexisting’ applies
to both a child’s access to a plan and his or her benefits once he or
she is in a plan," said Gibbs.

Unless, of course, the insurance companies decide to take the issue to
court, as they do–too often successfully–with any rule or regulation
they dislike. That will make interesting news: "Blue Cross vs. children
with asthma, diabetes, heart irregularities, hay fever or ear

Here’s the lead of the Times story by Robert Pear:

WASHINGTON — Just days after President Obama
signed the new health care law, insurance companies are already arguing
that, at least for now, they do not have to provide one of the benefits
that the president calls a centerpiece of the law: coverage for certain
children with pre-existing conditions.

Mr. Obama, speaking at a health care rally in northern Virginia on
March 19, said, “Starting this year, insurance companies will be banned
forever from denying coverage to children with pre-existing

The authors of the law say they meant to ban all forms of discrimination against children with pre-existing conditions like asthma, diabetes, birth defects, orthopedic problems, leukemia, cystic fibrosis and sickle cell disease.
The goal, they say, was to provide those youngsters with access to
insurance and to a full range of benefits once they are in a health

To insurance companies, the language of the law is not so clear.

Insurers agree that if they provide insurance for a child, they must
cover pre-existing conditions. But, they say, the law does not require
them to write insurance for the child and it does not guarantee the
“availability of coverage” for all until 2014.

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.”

Congressional Democrats were furious when they learned that some insurers disagreed with their interpretation of the law.

“The concept that insurance companies would even seek to deny children
coverage exemplifies why we fought for this reform,” said
Representative Henry A. Waxman, Democrat of California and chairman of the Energy and Commerce Committee.

 In case you’re wondering how many ways an insurance company can refuse to provide you coverage, here’s a taste.
Even taking Lipitor or having the wrong kind of job will do it.  And
here’s the story of a father and son denied health insurance because the child was treated for one ear infection.

And of course, insurance companies won’t ever sell health coverage to a
family expecting a child. That’s because the industry wants to "kick
the tires" on the infant before allowing it to be insured–to be
absolutely sure the infant is absolutely healthy first, and won’t cost
the company any real money.

It’s battles like this one that will keep alive the idea of a public
option, or Medicare-for-all. There’s no way that private insurers will
give in to even the smallest point of regulation without a costly,
lawyer-filled delaying action.

Consumer Watchdog
Consumer Watchdog
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