Gap in Health Care Coverage for Sick Kids

The Obama administration is scrambling to fix a potential problem with a much-touted benefit of its new health care law, a gap in coverage improvements for children in poor health, officials said Tuesday.

Under the new law, insurance companies still would be able to refuse new coverage to children because of a pre-existing medical problem, said Karen Lightfoot, spokeswoman for the House Energy and Commerce Committee, one of the main congressional panels that wrote the bill President Obama signed into law Tuesday.

However, if a child is accepted for coverage, or is already covered, the insurer cannot exclude payment for treating a particular illness, as sometimes happens now. For example, if a child has asthma, the insurance company cannot write a policy that excludes that condition from coverage. The new safeguard will be in place later this year.

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In recent speeches, Obama has given the impression that the immediate benefit for kids is much more robust.

Full protection for children would not come until 2014, said Kate Cyrul, a spokeswoman for the Senate Health, Education, Labor and Pensions Committee, another panel that authored the legislation. That's the same year when insurance companies could no longer deny coverage to any person on account of health problems.

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Obama's public statements conveyed the impression that the new protections for kids were sweeping and straightforward.

"This is a patient's bill of rights on steroids," the president said Friday at George Mason University in Virginia. "Starting this year, thousands of uninsured Americans with pre-existing conditions will be able to purchase health insurance, some for the very first time. Starting this year, insurance companies will be banned forever from denying coverage to children with pre-existing conditions."

And Saturday, addressing House Democrats as they approached a make-or-break vote on the bill, Obama said: "This year ... parents who are worried about getting coverage for their children with pre-existing conditions now are assured that insurance companies have to give them coverage - this year."

Late Tuesday, the administration said Health and Human Services Secretary Kathleen Sebelius would try to resolve the situation by issuing new regulations. The Obama administration interprets the law to mean that kids can't be denied coverage, as the president has said repeatedly.

"To ensure that there is no ambiguity on this point, the secretary of HHS is preparing to issue regulations next month making it clear that the term 'pre-existing exclusion' applies to both a child's access to a plan and his or her benefits once he or she is in the plan for all plans newly sold in this country six months from today," HHS spokesman Nick Papas said.

The coverage problem mainly affects parents who purchase their own coverage for the family, as many self-employed people have to do. Families covered through employer plans typically do not have to worry about being denied coverage because of pre-existing conditions.

Parents whose kids are turned down by an insurer would still have a fallback under the law. They could seek coverage through state high-risk insurance pools slated for a major infusion of federal funds.

The high-risk pools are intended to serve as a backstop until 2014, when insurers no longer would be able to deny coverage to those in frail health. That same year, new insurance markets would open for business, and the government would begin to provide tax credits to help millions of Americans pay premiums.

An insurance industry group says the language in the law that pertains to consumer protections for kids is difficult to parse.

"We're taking a closer look at it to see what exactly the requirement will be," said Robert Zirkelbach, spokesman for America's Health Insurance Plans, the main industry lobby.

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