HHS limits, but can't eliminate, child-only policy double-standards

The New York Times: "The Obama administration, aiming to encourage health insurance companies to offer child-only policies, said Wednesday that they could charge higher premiums for coverage of children with serious medical problems, if state law allowed it. ... Earlier this year, major insurers, faced with an unprofitable business, stopped issuing new child-only policies. They said that the Obama administration's interpretation of the new health care law would allow families to buy such coverage at the last minute, when children became ill and were headed to the hospital" (Pear, 10/13).

CNN: "Consumer protections built into the act prohibit all employer plans and all new plans in the individual market from denying coverage to children age 18 and younger who have pre-existing conditions, but it can't force insurers to offer policies for children. … Child-only policies are an option for those whose employers don't offer family coverage or who don't want to or can't afford to buy insurance for the whole family" (10/14).

National Journal reports on the new announcement that responds to insurers that "America's Health Insurance Plans spokesman Robert Zirkelbach said insurance companies would continue to work with HHS to stabilize the child-only market, but expressed continued concern over families applying for coverage after their children are sick" (McCarthy, 10/13).

Kaiser Health News: "Some insurers want to allow healthy children to enroll year-round but only have a limited 'open season' for ones with pre-existing conditions. Not so fast, HHS Secretary Kathleen Sebelius said in a letter to the National Association of Insurance Commissioners. Such an approach is legally questionable and 'inconsistent with the language and intent' of the health care law, Sebelius wrote. … HHS has estimated that 31,000 to 72,000 uninsured children with pre-existing conditions will gain coverage due to the provision between now and 2013. And 90,000 insured children will get coverage for pre-existing conditions that have been excluded from coverage, the department estimates" (Carey, 10/13).

Orlando Sentinel: "Now federal officials are hoping states will apply pressure too. ...  Some states, including Colorado, Oregon and Washington, have established uniform open-enrollment periods — setting aside certain times of the year when the child-only policies can be sold. The idea, they say, is to prevent families from signing up for coverage only when their children get very ill and their costs suddenly skyrocket. By creating uniform enrollment periods, federal officials say that no insurance company receives a disproportionate share of children with pre-existing conditions, because all insurers must accept the children during the same period" (Shrieves, 10/13).

The Hill Healthwatch blog noted that officials also "announced that Kaiser Permanente of the mid-Atlantic may start offering child-only policies in Maryland. The agreement is subject to the Maryland General Assembly approving the creation of an open enrollment period for the plans so families can't wait until their children are sick before enrolling them" (Pecquet, 10/13).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.