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.
Read more: http://www.miamiherald.com/...
So, if you are too poor to pay for a family policy but want one for your kids your 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 and 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. Just ask any parent who has to rely on the Emergency Department of their local hospital for health care.
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 (including my own State of New York) follows their lead.
Otherwise health insurance companies will continue to socialize the profits they make and pass the burden of higher health care costs that "emergency department only" health care service for the uninsured onto taxpayers and policy holders. Not to mention the increased likelihood of death or lifelong disability for the children denied coverage.
In short, we will end up with GOP health care: more expensive, less effective, and less and less available to more and more Americans, unless our states do what needs to be done (because a GOP Congress doesn't give a damn for anyone but insurance companies' bottom lines):
AMY GOODMAN: As lawmakers in Washington argue about healthcare reform, the state of Vermont is taking matters into their own hands. Vermont Governor Peter Shumlin is working with state legislators to create a single-payer system. Governor Shumlin made the creation of a single-payer system a cornerstone of his campaign and hopes to have a plan in place by 2014. He is a first-term governor in Vermont who was inaugurated earlier this month. He joins us now by Skype.
We welcome you, from Montpelier, Vermont, and want to talk about—as the House of Representatives in Washington this week repealed President Obama’s healthcare reform bill—of course, the Senate says they won’t go along with it—Vermont went a very different route. You had this rare joint session of the legislature with your whole congressional delegation, and you were addressed by a Harvard consultant, an economist, who laid out different proposals for single payer. You are leading this charge, Governor Shumlin. Why?
GOV. PETER SHUMLIN: Well, you know, I just see it very differently than the Republicans in Congress. I was elected governor to create jobs and to ensure that Vermonters have a better and more hopeful economic future. The biggest challenge for business in Vermont, or one of them, is the rising cost of healthcare. And I think what we want to do here in Vermont is to create a single pool, much like General Motors, Ford, Oracle, ensure that healthcare is a right and not a privilege, and use technology and other methods to contain cost. We want to have universal access. We want to be the first state where health insurance follows the individual and is not a requirement of the employer—I think that will be a huge jobs creator. And most importantly, we have to contain cost.
Here’s our challenge. Our premiums go up 10, 15, 20 percent a year. This is true in the rest of the country, as well. They are killing small business. They’re killing middle-class Americans, who have been kicked in the teeth over the last several years. What our plan will do is create a single pool, get the insurance company profits, the pharmaceutical company profits, the other folks that are mining the system to make a lot of money on the backs of our illnesses, and ensure that we’re using those dollars to make Vermonters healthy. So, a single pool that uses technology to ensure that we get rid of the waste and dedicate those dollars to making Vermonters healthy.
JUAN GONZALEZ: And how would the options that you are looking at differ on the issue that the Republicans have centered in on, the issue of individual mandates, that people must carry insurance?
GOV. PETER SHUMLIN: Well, you know, the individual mandate is going to be important to any success of healthcare. I mean, let’s look what we’re doing in this country, that every other single country in the world seems to have figured out. You cannot just have a system that is designed to reward providers and others for waste and inefficiency. You can’t have a system that is designed, frankly, to reward financially those that do the most to you and not necessarily keep you the healthiest.
So there are three things that we want our system to do. The first is, we’re wasting eight to 10 cents on the dollar in Vermont—frankly, in the rest of the country—chasing money around. No sane person would do that. We all know what we do. If we have insurance, we get the bill from our provider. Then the next envelope comes from the insurer. You wait for four or five of them to build up before you figure out what share you’re going to pay as an insured family and what share they’re going to pay. That is extraordinarily inefficient. We want to be the first state in the country that has the Green Mountain healthcare card. When you come out of your provider’s office, you pay your co-pay right there on the spot, just as you would never leave the grocery store without paying your bill there. That saves eight percent, we estimate, according to Dr. William Hsiao, right off the top. Then we want to use the same technology to have our health records on that card so that providers can actually know what the last provider did to you when you show up. That will get rid of the duplication and the waste in the system. And finally, we want to be the first state in the country that rewards providers for keeping you healthy as opposed the number of tests and procedures that they run you through, which happens to be the current system.
The current system in America is unaffordable. I think Democrats and Republicans can agree on that. If we stay on the current course, we will be spending the lion’s share of our income on healthcare. It will bankrupt our businesses. It puts us at a competitive disadvantage with all of the other countries who have figured this out.
My vision is that if Vermont can get this right, the other states will follow. Now, I’ve spoken with the President. We work together with our congressional delegation, with Secretary Sebelius. We need some waivers to make this happen. And what they’re saying is, "As long as you’re not lowering standards," which we’re not, "we want to work with you. We want the states to be laboratories for change." So, it’s an ambitious goal. We understand the land mines that lie out there, the special interests and the folks who are profiteering from our healthcare system, but we’re going to give it our best shot and try, lead the country.