Heartless Insurers’ Refusal to Cover Sick Kids, Reminds Us Why We Needed Reform
March 29, 2010
(ChattahBox)—Heartless, callous, inhuman, ruthless; all of these words perfectly describe the cold-hearted tactics and business plans of health insurance companies. But truth-be told, this depiction pretty much describes most corporations. However, most profit driven calculations made by corporations, won’t determine whether a person lives or dies. When a health insurance company decides not to offer insurance coverage to sick people or refuses to cover children born with pre-existing conditions, lives are lost. And families go bankrupt trying to obtain healthcare for their children. Under the current system, before all of the provisions of the new healthcare reform bill become enacted into law in 2014, insurance companies say they are not required to offer insurance to children with pre-existing conditions, despite what the new law states, because they are not legally required to offer insurance to every American, until 2014. Until that time, children can die, as they keep careful watch on their profit margins.
The new Patient Protection and Affordable Care Act states that health plans and insurers offering individual or group coverage “may not impose any pre-existing condition exclusion with respect to such plan or coverage” for children under 19, starting in “plan years” that begin on or after Sept. 23, 2010. And President Obama has hailed the end to denial of insurance to children with pre-existing conditions, as one of the key provisions of the historic legislation that would take effect almost immediately.
But the insurance company lawyers have decided they are not legally required to offer health insurance plans to children with pre-existing conditions until 2014, and sick dying children be damned.
According to the report in the New York Times, insurance companies may take the drastic step of refusing to cover entire families, to avoid providing benefits to sick children:
“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.”’
So, until the “guaranteed issue” requirement kicks in, insurers contend they can still refuse coverage to not only children with pre-existing conditions, but anyone they want. And consumer advocates fear that insurers, rather then refuse coverage for a child’s pre-existing condition, may decide to refuse coverage for all members of the family.
“A White House spokesman said the administration planned to issue regulations setting forth its view that “the term ‘pre-existing’ applies to both a child’s access to a plan and his or her benefits once he or she is in a plan.”
A joint statement released by Democratic Reps. Henry A. Waxman, Sander Levin, and George Miller, states they are confident any apparent loopholes in the new law can be remedied:
“Under the legislation … plans that include coverage of children cannot deny coverage to a child based upon a pre-existing condition,” the joint statement said. “We have been assured by the Department of Health and Human Services that any possible ambiguity in the underlying bill can be addressed by the Secretary with regulation.”
And Health and Human Services spokesman Nick Papa, said “To ensure that there is no ambiguity on this point, the Secretary of HHS is preparing to issue regulations next month making it clear that the term ‘pre-existing exclusion’ applies to both a child’s access to a plan and to his or her benefits once he or she is in the plan.”
Democratic lawmakers are outraged at the health insurer’s heartless parsing of the new law to deny coverage.
Rep. Henry A. Waxman(D-CA), chairman of the Energy and Commerce Committee, said “The concept that insurance companies would even seek to deny children coverage exemplifies why we fought for this reform.”
Sen. JohnRockefeller (D-WV), chairman of the Senate commerce committee, said “The ink has not yet dried on the health care reform bill, and already some deplorable health insurance companies are trying to duck away from covering children with pre-existing conditions. This is outrageous.”
The existing loophole would only apply to families purchasing coverage for children in the private market and whose children have a gap in insurance coverage lasting for more than two months. But one thing is clear; until 2014 when insurers can no longer use health status in setting premiums, insurance companies are free to raise their rates to cover the costs of insuring sick children.
Photo Source: UC Davis Health System