Administration Goes to Bat for Children With Pre-Existing Conditions – Say Ahhh! A Children’s Health Policy Blog

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

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
  •  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.

Scroll to Top