Debates about whether there should be a health overhaul have morphed into ones over what the bill will actually do. It is more than a thousand pages long, and much of the prose refers to rules already on the books or other parts of the bill. So there's a legislative hall of mirrors effect, and reading it is confusing, maybe on purpose. (Here's the bill.)
The complexity might explain why the bill-writers appear to have made a big goof. Yesterday it came to light that new insurance regulations that will force HMOs to take sick kids as customers don't kick in until 2014, rather than right away. (Read about it in this AP report.)
In practice, the government already provides ways for sick kids to get coverage, including through its Medicaid and CHIP programs for kids. Children with serious disabilities qualify for Medicaid's "aged, blind and disabled" coverage. Many children who get diagnosed with serious illnesses, and whose families are uninsured, are retroactively enrolled in government programs. When I wrote a story about kids with cancer two years ago a large percentage of the pediatric cancer patients at Johns Hopkins were in this situation--and were getting top notch care.
But still, one of the major selling points of the health overhaul is that it will force all insurance companies to stop discriminating by excluding pre-existing conditions from coverage. HMOs must offer coverage to all comers. The President has said that for children, the new rules will apply "starting this year."
Now it turns out the writers of the legislation may have forgotten to write the accelerated timeline for children into the bill. The section in question is this one, on page 777, which was meant to make the rules about taking all comers kick in right away for those under the age of 19:
(e) Section 1253 of this Act is amended insert before the period the following: ‘‘, except that—‘‘(1) section 1251 shall take effect on the date of enactment of this Act; and ‘‘(2) the provisions of section 2704 of the Public Health Service Act (as amended by section 1201), as they apply to enrollees who are under 19 years of age, shall become effective for plan years beginning on or after the date that is 6 months after the date of enactment of this Act.’’.
The legislative labyrinth is hard to navigate. But if you look at pages 36, 38 and 44, it appears as though the special six-month timeline for kids only applies to the exclusion (page 36) but not the guaranteed issue rule (page 38)--when changing the date the new rules apply (page 44). End result: It doesn't force them to offer insurance to kids with pre-existing conditions anytime this year.
This is a major screw-up by the White House and its allies on the Hill, especially since they've had a year to work this out.
White House spokesman Robert Gibbs, during his Q&A session yesterday, denied that there was a problem, while also promising to fix the it with a separate regulation. See this exchange:
Q Can I ask on another subject? On another subject I wanted to ask about -- the President has been saying the last few days that one of the biggest benefits of the new health care law is that within six months children will no longer have preexisting conditions, and now various health experts are saying, well, when you read it more closely that’s not true. So was the public misled on that?
MR. GIBBS: No, the law is clear, Ed, that insurance companies cannot deny coverage to a child based on a preexisting condition. Under the act, the plan includes -- plans that include coverage for children cannot deny coverage based on a preexisting condition. To ensure that there is no ambiguity on this, the Secretary of Health and Human Services, Kathleen Sebelius, is preparing to issue regulations next month making sure that the term “preexisting” applies to both a child’s access to a plan and his or her benefits once he or she is in a plan.
America's Health Insurance Plans, which has supported the idea of guaranteed issue as long as it was coupled with a powerful mandate that everyone must buy insurance, says that the result is that guaranteed issue for kids doesn't kick in until 2014. Spokesman Robert Zirkelbach emails us: "We are focused on implementing the legislation as written."
SOURCE: blogs.forbes.com
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