The NYT's Robert Pear continues coverage of the key story coming out of last week's passage and signing of health insurance reform: the contention by insurers that a key part of the law that is supposed to take effect immediately will not. That is, they are asserting that the provision that prevents them from denying coverage to children with pre-existing conditions--intended to begin with policies that begin on or after Sept. 23, 2010--doesn't do that at all.
Insurers agree that if they provide insurance for a child, they must cover pre-existing conditions. But, they say, the law does not require them to write insurance for the child and it does not guarantee the “availability of coverage” for all until 2014.
William G. Schiffbauer, a lawyer whose clients include employers and insurance companies, said: “The fine print differs from the larger political message. If a company sells insurance, it will have to cover pre-existing conditions for children covered by the policy. But it does not have to sell to somebody with a pre-existing condition. And the insurer could increase premiums to cover the additional cost.”
...[I]nsurers say, until 2014, the law does not require them to write insurance at all for the child or the family. In the language of insurance, the law does not include a “guaranteed issue” requirement before then.
This is why insurance companies have lawyers. The Obama administration insists that it can close this loophole with strong regulations, but the insurers are ready for that.
A White House spokesman said the administration planned to issue regulations setting forth its view that “the term ‘pre-existing’ applies to both a child’s access to a plan and his or her benefits once he or she is in a plan.” But lawyers said the rules could be challenged in court if they went beyond the law or were inconsistent with it.
The language on this portion of the legislation was problematic and didn't move up the guaranteed issue of plans, and it should come as a surprise to no one that the insurers jumped on that loophole within hours of the bill being signed to show their intent to flout it. That's a preview of things to come, probably, as they have four years to tease out every other loophole in the law they can find to continue to deny coverage and raise premiums.
For that reason, it would be smart for Congress to put them on notice that the reform effort didn't end last week by passing a stand-alone bill clarifying the issue of pre-existing conditions for children. There are plenty of stand-alone bills that could be forwarded between now and 2014: the Senate should pass the anti-trust exemption repeal that the House passed in December; Feinstein's medical insurance rate review authority that was included in Obama's plan but didn't make the Byrd Rule cut to remain in the reconciliation fix; and finally, the public option proposal that we've been promised by Reid and Harkin that we'll get eventually, and that Alan Grayson has already found significant support for.
The last thing members of Congress will want to do now is take up any kind of healthcare reform again, but the job isn't finished. The place to start is undoubtedly making their promise to sick children iron-clad.