No one could have predicted that insurance companies would find ways around the Affordable Care Act when it came down to actually having to provide coverage to sick people.
As arguments about the constitutionality of healthcare reform reverberate through courtrooms in Florida and across the nation, two provisions that have already kicked in are sparking opposite reactions from insurers.
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.
But the provision requiring many employers to insure adult children up to age 26 through their parents’ plans has glided into practice with virtually no opposition because healthcare consultants, insurance companies and major employers believe cost increases will be minimal and benefits widespread.
Why the difference? Because they get the extra premiums for insuring adult children and have less of risk of having to pay out to cover illnesses. The policies that insurers are dropping are the plans otherwise uninsured families could purchase just to cover a child--children already covered by family plans are not being dropped.
So one of the most laudable and important elements of the Affordable Care Act--making sure sick kids have health care that their parents can afford, is being undermined. The insurers have a point in that, until 2014 when the mandate kicks in, parents can wait until their kid gets sick to get coverage for them. But that's not really the fault of deadbeat parents--it's the fault of too expensive insurance premiums for many families to afford. It's frankly a problem that should have been foreseen both by lawmakers and by regulators, and should inform policy-makers as they move forward with implementation of the ACA. Insurers are going to exploit every single loophole they can find to avoid covering sick people.
Of course, a public option or Medicare buy-in could take care of everyone with a pre-existing condition, and likely more affordably for their families. And it would be constitutional. And expanding publicly available coverage options might just provide enough competition to private insurers to make them more compliant with the law.
Steven D has more in this diary.