Obama plan shows gap in children’s coverage

President Barack Obama’s top health care official has put health insurers on notice that the new health overhaul law requires them to cover children with medical problems, trying to dispel uncertainty over a much-publicized benefit.

It remained unclear if the sternly worded letter from Health and Human Services Secretary Kathleen Sebelius would settle a dispute over a widely touted achievement of the new health care law.
The fine print of the law appears to have been less than completely clear on whether children with health problems are guaranteed coverage starting this year. If there’s a problem, some parents and their children may have to wait a long time: The legislation’s broad ban on denying coverage to any person on account of a health condition doesn’t take effect until 2014.

The sticking point is that the immediate benefit for children may not be as sweeping as Obama has claimed in extolling the legislation.

That’s because the law can also be read to mean that if an insurance company accepts a particular
child, it cannot write a policy for a child that excludes coverage for a given condition. For example, if the child has asthma, the insurer cannot exclude inhalers and respiratory care from coverage, as sometimes happens now.

But the company could still turn down the child altogether.

In a letter to the main industry trade group, Sebelius attempted to remove any doubt.

“Health insurance reform is designed to prevent any child from being denied coverage because he or she has a pre-existing condition,” she wrote in a letter to America’s Health Insurance Plans. “Now is not the time to search for nonexistent loopholes that preserve a broken system.”

Sebelius specified that children with a pre-existing medical problem may not be denied access to their parents’ coverage under the new law. Furthermore, insurers will not be able to insure a child but exclude treatments for a particular medical problem.