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Not Quite as Advertised

March 24, 2010 - by Donny Shaw

As Democrats ramped up their push to sell health care reform, one of the benefits they said would come right away was a ban on denying coverage for kids who have pre-existing conditions. “This year … parents who are worried about getting coverage for their children with pre-existing conditions now are assured that insurance companies have to give them coverage — this year,” President Obama said on Saturday in a televised meeting with House Democrats.

But, as the AP reports this morning, it doesn’t actually work that way.

Under the new law, insurance companies still would be able to refuse new coverage to children because of a pre-existing medical problem, said Karen Lightfoot, spokeswoman for the House Energy and Commerce Committee, one of the main congressional panels that wrote the bill Obama signed into law Tuesday.

However, if a child is accepted for coverage, or is already covered, the insurer cannot exclude payment for treating a particular illness, as sometimes happens now. For example, if a child has asthma, the insurance company cannot write a policy that excludes that condition from coverage. The new safeguard will be in place later this year.

The actual ban on denying insurance coverage for children with pre-existing conditions would start in 2014, which is when a similar ban begins for all people. The AP is reporting this as a mistake — that the letter of the law created a gap in insurance coverage where none was intended. But a close reading of the Democrats’ descriptions of the bill makes it seem like it was by design.

Here’s how it is listed in the congressional Democrats’ official implementation timeline (.pdf), under the benefits “for those privately insured” section as a “key provision that takes effect immediately”:

NO DISCRIMINATON AGAINST CHILDREN WITH PRE‐EXISTING CONDITIONS—Prohibits health plans from denying coverage to children with pre‐existing conditions. Effective 6 months after enactment. (Beginning in 2014, this prohibition would apply to adults as well.)

The mistake appears to be in Obama’s understanding of the law, not in the law itself. I guess that’s what happens when the White House takes a hands-off approach and leaves the legislative details up to Congress.

Image from seiuhealthcare775nw used under a CC license.

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Comments

  • coolsilver 03/24/2010 8:22am

    Must not have read the bill before he signed it.

  • KingGeedorah 03/24/2010 12:55pm

    “NO DISCRIMINATON AGAINST CHILDREN WITH PRE‐EXISTING CONDITIONS—Prohibits health plans from denying coverage to children with pre‐existing conditions. Effective 6 months after enactment. (Beginning in 2014, this prohibition would apply to adults as well.)”

    Wouldn’t that mean that 6 months after the Bill is enacted? It says 6 months after enactment and the bill was enacted into law just the other day. I don’t see how the wording would mean anything else. The term enactment, in its context above, means the passing of a law by a legislative body. This has been done, as we all know.

  • Comm_reply
    horowitz 03/24/2010 1:05pm

    Yeah, I agree with you, the bill has been passed, signed and it says 6 months after. So I don’t get what the article is trying to say either.

  • Comm_reply
    KingGeedorah 03/24/2010 1:09pm

    Look at the last couple lines from the AP article:

    “We’re taking a closer look at it to see what exactly the requirement will be,” said Robert Zirkelbach, spokesman for America’s Health Insurance Plans, the main industry lobby.

    All that I get from that quote is that Insurance Companies are sifting through every line of this new law looking for loop holes and exits, because the wording is not difficult to parse.

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