Today the Obama Administration displayed its firm commitment to stand up for children with pre-existing conditions.  HHS Secretary Sebelius sent a letter to the National Association of Insurance Commissioners condemning the insurance industry for failing to follow through on their commitment to allow families with sick or disabled children to buy child-only insurance coverage.  (As readers of this blog know, the action was necessitated by a number of major insurance companies abandoning their public commitment to allow families with sick or disabled children to buy child-only plans in the individual market, as envisioned in the Affordable Care Act.)

Citing the leadership already apparent in states such as California and New Hampshire, the letter outlined a number of concrete steps that the nation’s insurance commissioners have at their disposal to stabilize the health insurance market for these children and ensure that families can secure the care that they need.  The range of tools available to states include:

• Requiring insurance companies to continue offering child-only plans through legislative or administrative action. Governor Schwarzenegger, for example, signed legislation (AB 2244) that prohibits insurers from selling new plans in California’s individual market for five years, unless they also offer child-only plans. New Hampshire used existing state law to require that all individual insurers, including those offering child-only plans, continue to provide such coverage.
• Establishing open enrollment policies, much like those used by employers, to sign children up for coverage during specified periods.  The letter reiterates that states can establish open enrollment periods to help stabilize the insurance market for children by addressing insurers’ concerns that families will wait until their children are sick before signing them up for coverage.  States including Colorado, Ohio, Oregon, and Washington have already put open enrollment periods in place. If well-designed, the open enrollment periods can help insurers to attract a wide range of children to their pool of covered enrollees while families receive critical protections, including the ability to enroll outside an open enrollment period when faced with a life changing event (such as birth of a child). As the letter sent by Secretary Sebelius to NAIC clarified, insurers with open enrollment policies cannot try to game the system outside the established periods by offering coverage to healthy children but denying coverage to children with a pre-existing condition.
•  Utilizing other available coverage options so that families with sick children can obtain the coverage they need. This includes allowing families who earn too much to qualify for public programs to buy-into Medicaid and CHIP at the state-negotiated rate, which often is more affordable than private insurance.  Medicaid and CHIP do not discriminate against families whose children have pre-existing conditions.
•  Making sure that the new federal and state Pre-Existing Condition Insurance Plans work for families. States can ensure that the “high risk pools” or pre-existing condition plans provide a fail-safe for children with pre-existing conditions who cannot find coverage in the private market.  These plans can and should provide the full range of pediatric benefits that children need to grow and develop, and be priced appropriately.

CCF released a public statement applauding the Administration’s actions and urging state insurance commissioners to do the same.    We would love to hear what steps your state is taking to preserve insurance options for children with pre-existing conditions.