Today the Obama Administration displayed its firm
commitment to stand up for children with pre-existing conditions. HHS Secretary Sebelius sent a letter to
the National Association of Insurance Commissioners condemning the insurance
industry for failing to follow through on their commitment to allow families
with sick or disabled children to buy child-only insurance coverage. (As readers of this blog know, the
action was necessitated by a number of major insurance companies abandoning
their public commitment to allow families with sick or disabled children to buy
child-only plans in the individual market, as envisioned in the Affordable Care
Act.)
Citing the leadership already apparent in states such as
California and New Hampshire, the letter outlined a number of concrete steps
that the nation’s insurance commissioners have at their disposal to stabilize
the health insurance market for these children and ensure that families can
secure the care that they need.
The range of tools available to states include:
- Requiring insurance companies to continue offering
child-only plans through legislative or administrative action. Governor
Schwarzenegger, for example, signed legislation (AB 2244) that prohibits
insurers from selling new plans in California’s individual market for five
years, unless they also offer child-only plans. New Hampshire used existing
state law to require that all individual insurers, including those offering
child-only plans, continue to provide such coverage. - Establishing open enrollment policies, much like those
used by employers, to sign children up for coverage during specified
periods. The letter reiterates
that states can establish open enrollment periods to help stabilize the
insurance market for children by addressing insurers’ concerns that families
will wait until their children are sick before signing them up for
coverage. States including
Colorado, Ohio, Oregon, and Washington have already put open enrollment periods
in place. If well-designed, the open enrollment periods can help insurers to
attract a wide range of children to their pool of covered enrollees while
families receive critical protections, including the ability to enroll outside
an open enrollment period when faced with a life changing event (such as birth
of a child). As the letter sent by Secretary Sebelius to NAIC clarified,
insurers with open enrollment policies cannot try to game the system outside
the established periods by offering coverage to healthy children but denying
coverage to children with a pre-existing condition. - Utilizing other available coverage options so that
families with sick children can obtain the coverage they need. This includes
allowing families who earn too much to qualify for public programs to buy-into
Medicaid and CHIP at the state-negotiated rate, which often is more affordable
than private insurance. Medicaid
and CHIP do not discriminate against families whose children have pre-existing
conditions. - Making sure that the new federal and state Pre-Existing
Condition Insurance Plans work for families. States can ensure that the “high
risk pools” or pre-existing condition plans provide a fail-safe for children
with pre-existing conditions who cannot find coverage in the private
market. These plans can and should
provide the full range of pediatric benefits that children need to grow and
develop, and be priced appropriately.
CCF released a public statement applauding the
Administration’s actions and urging state insurance commissioners to do the
same. We would love to
hear what steps your state is taking to preserve insurance options for children
with pre-existing conditions.