By Julie Silas (Children’s Defense
Fund-California) and Mike Odeh (Children Now), with the
100% Campaign
While health insurers are pulling child-only plans out of
the individual insurance market in a majority of states, California stands as a
model in realizing the Affordable Care Act (ACA) and envisioning a reformed
coverage system where the injustice against children is finally put to an end.
With strong leadership and committed policymakers,
children’s coverage doesn’t have to take a back seat to
politics. California stands in stark contrast to some 34 states across the country, where
insurance companies have chosen to pull out completely of the child-only
private insurance market. That’s because in California, elected leaders
such as California Assembly Member Mike Feuer and Insurance Commissioner Dave
Jones put children first, moved forward legislation
to
ensure private insurers would not abandon children, and used their bully pulpit
to let families know.
The California law that prevents insurers from denying
coverage for children with asthma, diabetes, or other pre-existing conditions
also created open enrollment periods in which there are limits on the premium
rates that families can be charged (i.e., children with pre-existing conditions
can not be charged more than twice the premiums as healthy children). The first
open enrollment period was initiated on January 1st and ends on March 1st. In
addition, There are additional, individual-specific open enrollment periods
like the month of the child’s birthday and the involuntary loss of coverage due
to a major life event.
California’s success is based on a strong collaboration
between health advocacy groups, legislators, and administrators (former
Governor Schwarzenegger signed the legislation and several state agencies are
working to promote it). The legislation did some very clever things to address
concerns about adverse selection that made it virtually impossible for insurers
to permanently leave the child-only market. Our friends at Health Access
California had the foresight to anticipate an exodus
of insurers from the market and were aggressive about instituting real consequences
for insurers who abandon the child-only market. Any insurer not offering
child-only coverage on January 1st is barred from participating in the entire
individual market for five years.
At the same time, families have several responsibilities.
For example, they must apply during the open enrollment periods in order to
keep premium prices affordable. While there are limits on premiums during open
enrollment periods, outside of those periods insurers can charge premiums with
almost no limits. Additionally, parents must keep their children covered or
risk premium surcharges (up to 20 percent). Families must know about these
conditions in order to avoid these very real, and expensive, consequences.
To spread the word, the same collaboration that successfully
passed this important legislation is working together to get the word out to
families. The 100% Campaign created materials in English and
Spanish for
families to learn more about the new insurance coverage rules, which our many
partners are using to let their communities know about the options now
available. We are partnering with
legislative offices, the California Department of Insurance, community-based
groups, and the Administration to reach out to families during the open
enrollment period. We are also using this as an opportunity to continue to get
the word out about the roughly 700,000 California children who are already
eligible for public programs, but not yet enrolled.
These options and protections provide important coverage
for children in California. Children’s health advocates must work together to
reach families and a population not often connected to public health and social
services systems. At the same time, we must stay vigilant to ensure that
companies don’t water-down provisions meant to protect consumers and strengthen
coverage, and that insurers are held accountable and do not abandon children in
order to carve out political positions. Our California experience shows that
while it’s not always easy to get insurers to do the right thing, it’s not impossible.