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Insurance companies agree to cover sick kids

The story so far: There was some ambiguity over whether the Affordable Care Act's immediate ban on preexisting conditions discrimination for kids also required insurers to offer coverage to sick kids. Kathleen Sebelius, the secretary of health and human services, said she would write regulations clarifying that it did. Some thought that would work, some didn't. I figured it would be about enough to persuade the insurers to cooperate, as this wasn't a very big deal from their standpoint and Sebelius could make their lives miserable in other ways.

And that seems to have been a smart bet. Last night, the insurers sent a reply (pdf) to Sebelius saying, "We await and will fully comply with regulations consistent with the principles described in your letter."

By Ezra Klein  |  March 30, 2010; 9:29 AM ET
 
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Comments

let us hope that sick children can receive medical insurance coverage.

if not them, who?
what speaks to valuing human life more than that?

Posted by: jkaren | March 30, 2010 9:41 AM | Report abuse

As the father of a child with a severe neuromuscular disease, I sincerely hope this isn't another p.r. feint.

Posted by: scarlota | March 30, 2010 9:46 AM | Report abuse

With all the heated rhetoric from both sides people forgot that the Regs clarify these things every time with healthcare legislation. Hipaa. Schip arra cobra etc. The only thing gained is the sense of doubt in how it will all play out.

Oh and more large companies are taking the prescription accounting charge (Prudential).

The fallout coninues including the most recent polls which we won't see around here

Posted by: visionbrkr | March 30, 2010 9:49 AM | Report abuse

With all the heated rhetoric from both sides people forgot that the Regs clarify these things every time with healthcare legislation. Hipaa. Schip arra cobra etc. The only thing gained is the sense of doubt in how it will all play out.

Oh and more large companies are taking the prescription accounting charge (Prudential).

The fallout coninues including the most recent polls which we won't see around here

Posted by: visionbrkr | March 30, 2010 9:49 AM | Report abuse

"I figured it would be about enough to persuade the insurers to cooperate, as...Sebelius could make their lives miserable in other ways."

This is my whole problem with this. They screwed up and wrote a law that didn't actually require what they wanted it to, and you seem to think the head of HHS ought to be able to threaten private companies to make them do things the law doesn't require them to do.

Posted by: ab13 | March 30, 2010 10:27 AM | Report abuse

Shame can be a powerful motivator. So can litigation.

Posted by: jade_7243 | March 30, 2010 10:34 AM | Report abuse

Congress clearly intended for insurers to cover sick kids - meaning both not excluding pre-existing conditions AND guarantee issue. The insurers were seeking to follow the letter but not the intent ... then Sebelius said she'd clarify the letter.

Posted by: weiwentg | March 30, 2010 10:46 AM | Report abuse

"you seem to think the head of HHS ought to be able to threaten private companies to make them do things the law doesn't require them to do."

Strike "seem to". Otherwise, you are correct.

Posted by: ostap666 | March 30, 2010 10:47 AM | Report abuse

@weiwentg: "The insurers were seeking to follow the letter but not the intent ... then Sebelius said she'd clarify the letter."

She can't clarify the letter. She would need a new bill to do that. The head of HHS can't just say, "Well, I know what the law says, but here's what I want it to say."

Someone in the other thread said that Ezra believes in the rule of man, not of law. You appear to have the same belief.

Posted by: ab13 | March 30, 2010 11:05 AM | Report abuse

Without discussing /Chevron/ deference, your post is missing some needed context. Under the Supreme Court's rulings, if the plain language of a statute is ambiguous (which most would concede is the case here) and an administrative agency charged with interpreting and applying the law (in this case, DoHHS) has a reasonable interpretation of that statute (which does not mean the best interpretation, but just one that sems rational), courts will defer to that reasonable interpretation. That legal landscape has to be considered as part of the insurance industy's decision not to fight this battle.

-- An administrative lawyer

Posted by: Anonymous_Coward | March 30, 2010 12:36 PM | Report abuse

*****She can't clarify the letter. She would need a new bill to do that.*****

Apparently she can, and has already done so.

It's a sad, sad day for the American way of life when something as unimportant as the health of American children is put before industry profits.

Posted by: Jasper999 | March 30, 2010 2:52 PM | Report abuse

Republicans want to repeal the Health Reform bill. This would allow Insurance companies to once again discriminate against children with pre existing conditions....They have no compassion or shame.....Do you really want Republicans to do this to our most vulnerable. Shameful,just plain shameful....

Posted by: johnnyk1 | March 30, 2010 4:46 PM | Report abuse

-----"Apparently she can, and has already done so."

No, she can't and has not. The insurers have just agreed to go along with this because they'd rather not be seen as wanting to deny coverage to kids. That doesn't change the fact that she cannot write the regulations in conflict with the law, and this is completely voluntary on the part of the insurers.

-----"It's a sad, sad day for the American way of life when something as unimportant as the health of American children is put before industry profits."

Oh please. Spare us the sanctimony. You can't have guaranteed issue without a mandate. No amount of "think about the children!" heartstring-pulling changes that.

Posted by: ab13 | March 30, 2010 5:51 PM | Report abuse

****No, she can't and has not.*****

She hasn't clarified the law? Um, ok...

*****The insurers have just agreed to go along with this because they'd rather not be seen as wanting to deny coverage to kids*****

Obviously.

*****That doesn't change the fact that she cannot write the regulations in conflict with the law*****

Who's saying she can write regulations that "conflict with the law?"

*****You can't have guaranteed issue without a mandate.*****

Nonsense. That's exactly what we now have -- on small scale.

Posted by: Jasper999 | March 30, 2010 6:26 PM | Report abuse

-----"She hasn't clarified the law? Um, ok..."

No, she hasn't. What she's done is say that they wanted the law to require covering children. She's clarified their intent. But the law still says they don't have to. There is nothing Sebelius can do to change the law.

----"Who's saying she can write regulations that "conflict with the law?"

You've suggested she can "clarify" the letter of the law and write the regulations such that they're required to cover children. This would be in conflict with the law, since the language in the bill does not require them to do so.

-----"Nonsense. That's exactly what we now have -- on small scale."

No we don't. There is no guaranteed issue in the individual market. Unless you mean with this new law we have it, but that would be a dumb point to make. Saying "You can't have guaranteed issue without a mandate" means you can't have a functioning market if you set it up that way.

Posted by: ab13 | March 30, 2010 6:41 PM | Report abuse

Did the insurers ever actually say they wouldn't cover sick kids? I don't think so.

Posted by: bmull | March 31, 2010 1:10 AM | Report abuse

*****No, she hasn't. What she's done is say that they wanted the law to require covering children.*****

Please. You're just grasping at straws. At our blog host reports:

"There was some ambiguity over whether the Affordable Care Act's immediate ban on preexisting conditions discrimination for kids also required insurers to offer coverage to sick kids. Kathleen Sebelius, the secretary of health and human services, said she would write regulations clarifying that it did. "

I mean, what part of "write regulations clarifying" don't you get?

****This would be in conflict with the law, since the language in the bill does not require them to do so.*****

But apparently it DOESN'T conflict with the law, at least not according to Sebelius. I mean, I guess you're entitled to whatever esoteric opinions you want, but it's rather irrelevant, as you don't get to make the call, and she does.

*****There is no guaranteed issue in the individual market. Unless you mean with this new law we have it*****

Well of course that's what I mean. I thought the whole point of these innumerable discussions was, you know, the NEW law just signed by POTUS. By "small scale" I mean the specific subject at hand: children. I'm aware full guaranteed issue doesn't kick in for a while yet. Apparently, though, it WILL now kick in with respect to kids.

Posted by: Jasper999 | March 31, 2010 2:53 PM | Report abuse

------"Please. You're just grasping at straws. At our blog host reports:

"There was some ambiguity over whether the Affordable Care Act's immediate ban on preexisting conditions discrimination for kids also required insurers to offer coverage to sick kids. Kathleen Sebelius, the secretary of health and human services, said she would write regulations clarifying that it did. "

I mean, what part of "write regulations clarifying" don't you get?"
-----------------------------------

No, I'm not grasping at anything, you just don't get it. She cannot write regulations that are in conflict with the law and expect those regulations to stand up to a legal challenge. If they wrote the law saying insurers must cover people with last names starting with A-C, when they actually intended to include A-D, she couldn't just "write regulations clarifying" that they meant A-D. She'd have to write a new law.

-----"But apparently it DOESN'T conflict with the law, at least not according to Sebelius. I mean, I guess you're entitled to whatever esoteric opinions you want, but it's rather irrelevant, as you don't get to make the call, and she does."
---------------------------------------

No, it does conflict with the law, but AHIP has agreed to go along with whatever she writes. If they wanted to mount a legal challenge to the regulations she writes they could and it's very likely they'd win. But they're not going to do so because it would be bad PR and Sebelius has made veiled threats that she'd try to hurt them in other ways if they do.

And you are wrong, she doesn't get to make the call, but she can bully insurers into complying with a regulation they have no legal obligation to follow.

-----"Well of course that's what I mean. I thought the whole point of these innumerable discussions was, you know, the NEW law just signed by POTUS."
---------------------------------

Well if that's what you meant then that's an unbelievably dumb point. When I say "you can't have guaranteed issue without a mandate" it ought to be exceedingly obvious that I mean that in practice the market breaks down if you do that, it's not a statement about the facts of the new law. If someone says "You can't have a campfire without marshmallows" they mean that it would be a bad idea to start a campfire without some marshmallows to roast, not that it is physically impossible to do so. But thank you Captain Obvious for pointing out that we do in fact have GI without a mandate.

Posted by: ab13 | March 31, 2010 4:44 PM | Report abuse

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