(Washington, D.C.) – Georgetown University Center for Children and Families Co-Executive Directors, Joan Alker and Jocelyn Guyer, issued the following statement on efforts by the Administration to improve access to coverage for children with pre-existing conditions.

“The Administration took strong action today to help ensure that children with pre-existing conditions can secure health care coverage. 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 private insurance in the individual market, as envisioned in the Affordable Care Act. Instead of rolling up their sleeves to find ways to make the provision work as intended, these companies have been playing politics with the lives of children in their effort to undermine the health reform law.

While only a small number of families are in need of individual insurance coverage for their children, they are a particularly vulnerable group. Typically, they lack access to affordable employer-based coverage, but also make too much to qualify for Medicaid or the Children’s Health Insurance Program. The Affordable Care Act was designed to ensure that even if their children have been diagnosed with autism, cancer, or another health care condition, these families would be able to buy them coverage in the individual insurance market.

We applaud the Administration for taking a firm stand on protecting children with pre-existing conditions and urge state insurance commissioners to do the same. The Administration has adopted a constructive, balanced approach to this problem. It has provided states with the tools needed to address insurance industry concerns over families waiting until their children are sick to enroll them in a plan while still upholding the fundamental principle that all of our children need coverage. Now the insurance industry needs to return to its promise to “fully comply” with efforts to make pre-existing condition exclusions for children a thing of the past, and to demonstrate it will work in good faith to adopt the more sweeping reforms envisioned for the years ahead.”

Background:

HHS Secretary Sebelius sent a letter to the National Association of Insurance Commissioners today 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. Citing the leadership already apparent in states such as California and New Hampshire, the letter outlines 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 toqualify 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.

###