WASHINGTON — Under pressure from the White House, health insurance companies
said Tuesday that they would comply with rules to be issued soon by the
Obama administration requiring them to cover children with pre-existing
medical problems.
“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 M. Ignagni, president of America’s Health Insurance Plans, a trade group. Accordingly,
she said, “we await and will fully comply with” the rules.
Ms. Ignagni made the commitment in a letter to Kathleen Sebelius, the secretary of health and human
services, who had said she feared that some insurers might exploit a
possible ambiguity in the new health care law to deny coverage to some
sick children.
The White House immediately claimed victory.
In a Twitter
message, Robert Gibbs,
the White House press secretary, scored the tug of war as “Kids 1,
insurance 0.”
Major provisions of the law take effect in 2014. Some, including a ban
on “pre-existing condition exclusions” for children under 19, take
effect in September. The law does not explicitly say that insurers must
sell insurance to families with such children this year, but Democratic
Congressional leaders and White House officials said that was their
intent.
To eliminate any ambiguity, Ms. Sebelius said, she will issue rules
defining the scope of the new law.
Under these rules, Ms. Sebelius said, “children with pre-existing
conditions may not be denied access to their parents’ health insurance
plan,” and “insurance companies will no longer be allowed to insure a
child but exclude treatments for that child’s pre-existing condition.”
In response to a question, Nick Papas, a spokesman for the Department of Health and Human Services, said the
rules would require insurers to offer coverage to children with
pre-existing conditions, including those who have never had health
insurance.
Ms. Sebelius said she was pleased that “insurance companies plan to do
the right thing.”
It was not immediately clear whether the rules would allow insurers to
charge higher premiums to families with children with pre-existing
conditions. Administration officials said they would be monitoring any
rate increases.
Some Democrats in Congress want Mr. Obama to take a tough line. If
insurers could raise premiums without limits, they would, in effect, be
denying coverage, Democrats say.
Some insurers said they were unclear about the language of the law,
based on differing accounts, and looked forward to detailed guidance
from the government.
“There has been some confusion regarding the elimination of pre-existing
condition evaluation for children in the health care bill,” said
Kristin E. Binns, a spokeswoman for WellPoint, one of the largest
insurers. She said the company would “follow the law on this and all
matters.”
Insurers said they would accept the administration’s reading of the law,
even if they did not fully agree with it, because they wanted to avoid a
showdown over the politically explosive issue of health insurance for
sick children.
Several lawyers said Congress could easily clear up any confusion by
revising the law. “The real solution here is a legislative fix so all
players in the industry can act according to a clear set of rules,” said
William G. Schiffbauer, a Washington lawyer whose clients include
employers and insurance companies.
Representative Allyson Y. Schwartz, Democrat of Pennsylvania, who helped
write a similar provision in an earlier version of the legislation,
said the new law “requires that all insurers issue insurance to children
regardless of health status, and cover all of their ailments,” starting
in September.
Jeff Smokler, a spokesman for the Blue Cross and Blue Shield
Association, said its member companies were “fully committed to
complying with the new law” and accepted the principles set forth by Ms.
Sebelius.
Gail K. Boudreaux, executive vice president of the UnitedHealth Group,
said she supported the administration’s effort to clarify the law “to
ensure that no child will be denied access to health insurance because
of a pre-existing condition.”
“We expect that the new regulations will eliminate any uncertainty about
the law’s intent,” Ms. Boudreaux said.
NY Times
Published: March 30, 2010