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


3 Responses to “Heartless Insurers’ Refusal to Cover Sick Kids, Reminds Us Why We Needed Reform”

  1. Old Man Dotes on March 29th, 2010 12:48 pm

    Anyone going to provide a Web page showing which health insurers have refused coverage to how many children between now and 2014, so we know who to boycott?

  2. Heartless Insurers' Refusal to Cover Sick Kids, Reminds Us Why We … Children Me on March 30th, 2010 3:30 am

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  3. Ken on March 30th, 2010 11:10 pm

    The Law on covering children for pre existing health conditions does not force Insurance companies to sell new policies to children with preexisting health conditions. That’s a fact jack. If the federal health department tries to write regulations forcing them to do so could be challenged in court.
    Am I supposed to believe a House full of lawyers could write such a faulty bill. Over 500 Representatives and 100 Senators and thousands of their staff members didn’t catch it , I doubt it. The loophole was put there is so insurance companies could publically challenged the law. Many Democrats wanted a public option which was taken out of this bill. What better way is there to show how the private insurance companies will steep to new lows for profits. They want the public to see this up front so they can sell the public option before Obama leaves office. I predict the insurance companies who operate for profit not our health will challenge it. They just can’t help themselves. I wouldn’t expect the insurance companies or Republicans to advertise this until the day after the bill was passed. They all know the loophole is there. Funny thing President Obama started selling this write away.
    By the way the real health insurance crises part II is coming. The large part of increasing real cost of spiraling health insurance has not been even talked about. Treating 35 million uninsured illegal undocumented people living in America . They are not in the insurance pool as paying clients ! When the rates increase to the point where they are choking us to death trying to cover or legal citizens then you may decide to allow Illegal immigrants to joint the insurance pool to flatten out the rates. Are you ready !!!

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