Loophole May Delay Coverage for Some Kids

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6-year-old Lucas Avant is one of many kids who may still be denied insurance until 2014 because of a loophole in the health care law about pre-existing conditions.
CBS

Like most 6-year-olds, Lucas Avant has few fears, but his parents worry more than most. Lucas has no health insurance. At 9 months old, doctors found he had a heart ailment.

They say he's now perfectly healthy, reports CBS News correspondent Ben Tracy, but he's been denied by six insurance companies because of his pre-existing condition.

"There's no reason why a healthy child should be denied health insurance that his family can pay for," says Lucas' father Jason Avant. "That seems absurd."

Complete Coverage: Health Care Reform

Democrats said health reform would fix this problem, forcing insurance companies to cover kids no matter what.

"This year, insurance companies will be banned forever from denying coverage to children with pre-existing conditions," said President Obama on March 19, 2010.

That's not how insurance companies see it. The bill says insurers "may not impose any pre-existing condition exclusion" for children under 19 as of Sept. 23, 2010. Insurance companies say that just means if they choose to cover a child they have to cover the pre-existing condition and its costs, but they don't actually have to offer new coverage to any child with pre-existing conditions until 2014.

More in "Users Guide to Health Care" Series:

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Primary Care Doctors Ask: Is it Worth It?
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Already Insured? Get Ready to Pay More
Feds Eye Big Savings from Health Reform
How Health Reform Affects Small Businesses

Last week the Associated Press reported that spokespersons for two Congressional committees, controlled by Democrats, that helped write the legislation agreed with the insurance industry interpretation. Republicans say Democrats botched the language in the bill in their rush to pass it.

"Children will not get the coverage they were promised," said Rep. David Dreier (R-Calif.). "This is the inevitable result of a closed, partisan process."

The White House is scrambling sending a letter to the insurance industry to clarify the bill. "We don't want to leave any ambiguity," says Secretary of Health and Human Services Kathleen Sebelius. "This won't be up to insurance companies to interpret. Parents can rest assured."

The Insurance Industry Association says, "We will implement any revisions that are made." Meanwhile, the Avants are still waiting, hoping it's just months and not years until Lucas gets insured.

More Coverage of Health Care Reform:

Summary of What's in the Law
Provisions Which Take Effect in Short-Term
Read the Text (PDF): Complete Senate Bill | Reconciliation Measure

  • Ben Tracy

    Ben Tracy is a CBS News White House correspondent based in Washington, D.C.