Health Industry To Cover Children With Existing Conditions

"Health plans recognize the significant hardship that a family faces when they are unable to obtain coverage for a child with a pre-existing condition," said Karen Ignagni, AHIP president and CEO.

"That is why health plans in 2008 proposed reforms to make pre-existing condition exclusions a thing of the past," Ms. Ignagni said.

She added that, "With respect to the provisions related to coverage of children, we await and will fully comply with regulations consistent with the principles described" in a letter that Ms. Sebelius sent to AHIP.

AHIP's position is that "the legislation that was enacted prohibits pre-existing condition exclusions for children starting in 6 months, and requires guaranteed coverage for children and adults starting in 2014," according to Robert Zirkelbach, the group's spokesman.

Its view–supported by the National Association of Insurance Commissioners as well as healthcare lawyers and consultants–is that the provision mandating that insurers allow children with preexisting conditions buy coverage doesn't kick in under the law until 2014.

But, the chairmen of the three House committees voiced indignation that the health care industry would consider resorting to "ambiguities in the legislation" in an effort not to comply with congressional intent.

The statement from the committee chairman said they had also been reassured that the problem could be addressed through regulation.

That is also the view of Sandy Praeger, Kansas insurance commissioner and chairman of the NAIC's healthcare task force.

"In looking at the bill, our experts were concerned there's no 'guaranteed issue' until 2014," Praeger said.

"'Guaranteed issue' means when you're out buying insurance, they have to offer coverage to anybody who wants to buy in – there's nothing about how much they can charge, but they have to offer it."

Ms. Praeger added that, Congress "intended there to be guaranteed issue, but the bill's not written that way…It's not in the law."

The provision included in the health care bill passed by Congress was included in legislation introduced in March 2009 by Rep. Allyson Schwartz, D-Pa.

In comments to the National Underwriter, Tali Israeli, Ms. Schwartz's press aide, said that "guaranteed issue" is what the provision says, but, in any event, Ms. Schwartz is pleased that the health industry has agreed to comply with the law."

Ms. Schwartz's view of the legislation intent was backed by Rep. Henry Waxman, D-Calif., chairman of the House Energy and Commerce Committee; Rep. Sander Levin, D-Mich., chairman of the House Ways and Means Committee; and Rep. George Miller, D-Calif., chairman of the House Education and Labor Committee.

In a statement, they said, "Under the legislation that Congress passed and the President signed March 23, plans that include coverage of children cannot deny coverage to a child based upon a pre-existing condition."

The statement added that, "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."

They said they "fully expect that this legislation will prevent insurance companies from denying coverage.

"The concept that insurance companies would even seek to deny children coverage exemplifies why we fought for this reform effort and will continue fighting to ensure all Americans have access to high quality, affordable care," the statement concluded.