By Julie Silas (Children’s Defense Fund-California) and Mike Odeh (Children Now), with the 100% Campaign

While health insurers are pulling child-only plans out of the individual insurance market in a majority of states, California stands as a model in realizing the Affordable Care Act (ACA) and envisioning a reformed coverage system where the injustice against children is finally put to an end.

With strong leadership and committed policymakers, children’s coverage doesn’t have to take a back seat to politics. California stands in stark contrast to some 34 states across the country, where insurance companies have chosen to pull out completely of the child-only private insurance market. That’s because in California, elected leaders such as California Assembly Member Mike Feuer and Insurance Commissioner Dave Jones put children first, moved forward legislation to ensure private insurers would not abandon children, and used their bully pulpit to let families know.

The California law that prevents insurers from denying coverage for children with asthma, diabetes, or other pre-existing conditions also created open enrollment periods in which there are limits on the premium rates that families can be charged (i.e., children with pre-existing conditions can not be charged more than twice the premiums as healthy children). The first open enrollment period was initiated on January 1st and ends on March 1st. In addition, There are additional, individual-specific open enrollment periods like the month of the child’s birthday and the involuntary loss of coverage due to a major life event.

California’s success is based on a strong collaboration between health advocacy groups, legislators, and administrators (former Governor Schwarzenegger signed the legislation and several state agencies are working to promote it). The legislation did some very clever things to address concerns about adverse selection that made it virtually impossible for insurers to permanently leave the child-only market. Our friends at Health Access California had the foresight to anticipate an exodus of insurers from the market and were aggressive about instituting real consequences for insurers who abandon the child-only market. Any insurer not offering child-only coverage on January 1st is barred from participating in the entire individual market for five years.  

At the same time, families have several responsibilities. For example, they must apply during the open enrollment periods in order to keep premium prices affordable. While there are limits on premiums during open enrollment periods, outside of those periods insurers can charge premiums with almost no limits. Additionally, parents must keep their children covered or risk premium surcharges (up to 20 percent). Families must know about these conditions in order to avoid these very real, and expensive, consequences.

To spread the word, the same collaboration that successfully passed this important legislation is working together to get the word out to families. The 100% Campaign created materials in English and Spanish for families to learn more about the new insurance coverage rules, which our many partners are using to let their communities know about the options now available.  We are partnering with legislative offices, the California Department of Insurance, community-based groups, and the Administration to reach out to families during the open enrollment period. We are also using this as an opportunity to continue to get the word out about the roughly 700,000 California children who are already eligible for public programs, but not yet enrolled.

These options and protections provide important coverage for children in California. Children’s health advocates must work together to reach families and a population not often connected to public health and social services systems. At the same time, we must stay vigilant to ensure that companies don’t water-down provisions meant to protect consumers and strengthen coverage, and that insurers are held accountable and do not abandon children in order to carve out political positions. Our California experience shows that while it’s not always easy to get insurers to do the right thing, it’s not impossible.