Federal Mandate on Children’s Preexisting Conditions Not Yet in Effect

Published May 31, 2016


Shortly after President Obama signed his health care overhaul into law, the White House discovered a discrepancy pertaining to the promised improved coverage for children in poor health.

“Starting this year, insurance companies will be banned forever from denying coverage to children with preexisting conditions,” the president claimed in a March speech at George Mason University.

Under the new law, however, it is not yet illegal for insurance companies to refuse new coverage to children because of a preexisting medical problem.

According to a spokeswoman for the House Energy and Commerce Committee, if a child is accepted for coverage or is already covered, the insurer cannot not exclude payment for treating a particular illness such as asthma. And as of 2014, no insurance company will be allowed to write a policy that excludes such a condition from coverage.

State Agencies Analyzing

According to Stephanie Goodman of the Texas Health and Human Services Commission, state agencies are still analyzing the requirements of the legislation regarding coverage for children.

“The Texas Health and Human Services Commission is analyzing the health reform bill’s affect on our state’s Medicaid and Children’s Health Insurance Program (CHIP) services,” said Goodman. “Private insurers are examining the requirements as well.”

The situation is limited largely to parents who purchase their own coverage for the family, as many self-employed people do. Families covered through employer plans cannot be denied coverage due to preexisting conditions without federal consequences – a ban that had previously been in place at the state level (see John R. Graham’s column on page 14).

Other Options Available

Parents who purchase insurance through the private market whose children are turned down by an insurer still have fallback options under the new law. They can seek coverage through state high-risk insurance pools slated for a combination of federal funds, for example.

In addition, many qualify for government programs.

“Low-income parents looking for health coverage for their children can apply for Medicaid or CHIP. One application covers both programs, and children in families earning up to 200 percent of the federal poverty level may qualify,” Goodman explained. “They can also turn to the high-risk pools.”

Goodman notes the high-risk pools are intended to serve as a backstop until 2014. At that point it will be illegal for insurance companies to deny coverage to any person on account of health problems.

Tabassum Rahmani ([email protected]) writes from Dublin, California.