The health reform law unfortunately was inadequate. It was filled with loopholes. No surprise then that Health Insurance companies are starting to exploit those loopholes to limit coverage — for children:
The requirement that children under 19 be granted insurance regardless of preexisting conditions has caused Blue Cross and Blue Shield of Florida and many other insurers to stop offering child-only coverage.
Insurers fear they will lose money because parents might sign up for coverage only when their children become sick. That is scheduled to change in 2014, when the law requires that virtually everyone have health insurance — a provision that a federal judge in Pensacola declared unconstitutional on Jan. 31
How can they get away with this? It’s easy:
Federal regulators set no enrollment time limits for children younger than 19 to sign up for insurance under individual plans. If an uninsured child was diagnosed with a serious illness, the child’s parents could sign up for insurance at that point — when costs are likely to be highest. That hurts insurers even more when parents haven’t been paying into the system along the way.
“There’s a powerful incentive to wait until after their children are sick” before signing up, Zirkelbach said.
Since that means families might tend not buy insurance for healthy children, the pool of insured children would probably have an inordinate percentage of those who are sick, said Randy Kammer, BCBSF’s vice president of regulatory affairs. That would drive up insurance costs for everyone.
BCBSF still covers all children when families sign up for policies, but has stopped offering the individual child policies. Kammer said she has heard that insurers in 29 states have stopped offering kids-only policies. Zirkelbach agreed the stoppage is widespread, though he didn’t have exact numbers.
A key difference between the two provisions is that employers generally insist on a limited open enrollment period during which workers must sign up for coverage for themselves and their families, said Robert Zirkelbach, spokesman for America’s Health Insurance Plans, the industry’s trade group.
So, if you are too poor to pay for a family policy but want one for your kids you’re out of luck. I don’t buy the “incentive” to wait excuse. And not surprisingly the health insurance industry trade group spokespeople offer no proof that that their alleged “fears” of kids being signed up only after they get sick would occur.
In my opinion the insurance companies just want to gouge poor to lower middle class people by forcing them to buy family policies even if they can’t afford them. Most poor parents want their kids covered even if they can’t afford coverage for themselves. Most parents don’t want to gamble with the health of their kids.
However, by refusing to offer “kids only” health care policies, insurance companies make it an all or nothing proposition: buy more expensive family coverage during the short window of opportunity to acquire it, or else. If you don’t have the money to buy family coverage, too bad. Your kids are screwed.
One more reason see why a single payer health care plan or even a public option would have been better than the health reform bill that did get passed. Vermont is moving toward a single payer plan. I can only hope that other states follow their lead.
your first sentence says it all, Steve: “The health reform law unfortunately was inadequate. It was filled with loopholes. No surprise then that Health Insurance companies are starting to exploit those loopholes”.
maybe Obama can give them another talking too. That works SO much better than, ya know, actually writing a bill with teeth in it. But Max Baucus is happy and that’s all that matters.
Pennsylvania insurers are dropping children’s coverage too. But don’t worry everyone, Bob Casey’s ON IT:
Now, interestingly enough, Senator Casey worked very hard for a public option in the HELP committee bill. But as we all know, Obama had already privately promised the insurance companies there would be no such item in the final language (despite traveling around telling everyone the exact opposite), so we got what Steve charitably calls “inadequate”.
When i was having trouble with TSA, one of Casey’s legislative aides told me that Senator Casey is powerless to do anything but pass laws (not true, of course). So maybe instead of haranguing insurance companies to “keep their promise” (seriously, someone needs to tell the Senate it’s not 1852 anymore, we don’t spit on our hands and shake on it), I hope he actually, ya know, passes a law.
I would definitely say that having a public option in the law would have been better than not having one, but I think that, and I am certain I am not alone here, that too would have been so woefully inadequate as to be a near-sham.
The problem is that health care is a) a human rights issue–how I prefer to see it when I talk with people who agree with me–and b) an economic issue, which is how I discuss it with people who need convincing that some form of national health is a necessary component of a healthy modern, urban society, in an economic sense. This is problematic, because the entire discussion of health care in mainstream political discourse has approached it as c) a political issue, which it is not in substance. Republicans need national health (or single payer, or Medicare for All, etc.) just as much as Democrats or anyone else does.
It was the general line (sorry to use the Leninist term, but it fits the sentence) of this blog to oppose the “kill the bill” crowd by correctly pointing out that passing a flawed bill–a national policy, importantly–would much more likely lead to actual good policy more quickly than not passing a bill at all. Having an actual but flawed policy demands fixing, but having no policy at all doesn’t, because there’s no policy to fix, just a problem that many people will imagine is natural, and therefore impossible to fix.
I sort of imagine that this is something like Prohibition in reverse, insofar as we have a national policy that will then be pushed forward at the state level, Massachusetts excepted, I suppose. There are also local things, at least in San Francisco which has a remarkably good policy, if admittedly inadequate, called “Healthy San Francisco.” California has some very good bills in the legislature, but the whole fiscal mess will postpone passage for some time, unfortunately.
Me, I think that realistically modifying and expanding Medicare is the best bet.
To clarify, “Massachusetts excepted” because they passed a statewide policy before the Affordable Care Act, not because they won’t modify or expand coverage in the future. I don’t know much about Massachusetts politics at this point.
I too would have preferred early medicare as a solution.
The insurance companies have been trying to destroy the law since it passed. Sebelius has had some success in turning back companies attempts to undermine the law.
I have no doubt that the government expected that would happen.
Lastly, I think the public option would have created just as many problems. Any kind of major policy shift creates cultural and structural problems. And I agree that the public option would have been very limited.
Stop whining about the bill and let’s use this ‘crisis’ to get more of what we want.
The insurers are forgetting something VERY important: ‘Protecting our children’ is one of the most powerful political motivators in this country.
Want to stop covering kids? Ok, we’ll accelerate the coming policies or just extend medicare to all under 18. But we need to make this seem like more of a crisis (and thereby frame it), rather than down-playing it in hopes of providing a fig leaf for an under-cooked policy.
And don’t give me any ‘but the Repugs control the house, so we shouldn’t try’ BS.
There are ways to get this done and we won’t find them without trying.