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Bruce Lesley's picture

With the entire nation buzzing over President Obama's historic health care victory, many Americans are trying to understand how this new law will affect their everyday lives. For some of our nation's most vulnerable children with special health care needs, President Obama has announced that, beginning this September, health insurance plans will no longer be allowed to deny coverage for children with pre-existing conditions. Done, right? Well, not so fast.

Immediately, some in the health insurance industry argued they might seek to avoid or ignore the provision. Health and Human Services (HHS) Secretary Kathleen Sebelius responded by asking America's Health Insurance Plans (AHIP) to urge its members to "cease any attempt to deny coverage to some of the youngest and most vulnerable Americans."

Congresswoman Allyson Schwartz, author of legislation to eliminate pre-existing condition exclusions for children, added, "Congress passed legislation to ensure that the six year old with cancer, the two year old with asthma and the 10 year old with diabetes will have access to meaningful affordable health care coverage. I hope that the insurance industry does the right thing and abides by the law to ensure that discrimination against kids with health care needs is strictly prohibited from here on out."

Fortunately, AHIP responded quickly to Secretary Sebelius, saying that health plans "recognize the significant hardship that a family faces when they are unable to obtain coverage for a child with a pre-existing condition" and they will "await and will fully comply with regulations consistent with the principles described in [Sebelius'] letter."

AHIP should be commended for its swift and appropriate response. Indeed, children's advocates look forward to September, when this provision of the law is scheduled to go into effect. According to George Washington University Professor Sara Rosenbaum, that will be the day when "a child who develops autism, or cancer, or sickle cell disease, or cystic fibrosis should not face discrimination either at the point of enrollment or following enrollment."

However, advocates of this critical provision and others like it must remain vigilant and pay careful attention to the details. While we are pleased by this sign of good faith by AHIP, it will not prevent an individual health insurance company from challenging the law. The powerful AHIP should publically dissuade any of its members from individually challenging the new law as it relates to the immediate coverage of preexisting conditions for children. Further, in a memorandum to its Board of Directors, U.S. Chamber of Commerce President Thomas Donohue announced that the Chamber would commit resources, including legal action, to fight the legislation and its implementation.

This is the case despite the HHS's commitment to promulgate regulations that ensure the intent of the law is reflected -- that no child with cystic fibrosis, asthma, juvenile diabetes, or any other illness is denied coverage ever again. Although children with disabilities cannot possibly overcome both the insurance industry and the Chamber of Commerce in a behind-the-scenes political battle, the difference-maker in such a fight is that the American public will not stand for such coverage denials to our nation's most vulnerable children.

Just this week, the national media attention focused on the story of Houston Tracy, a newborn who had been denied health insurance coverage from Blue Cross Blue Shield of Texas for what the company had declared was a "pre-existing condition." Houston needed life-saving surgery to repair a heart defect and, solely because the media publicized his story, Blue Cross was shamed into finding a solution that led to coverage for the child's care and treatment. For this boy and the thousands of children like him across the country, the ban on pre-existing condition denials has real consequences that could save his life.

Thus, while AHIP has pledged to "fully comply with regulations" on this matter, this will not prevent others from challenging the law unless AHIP succeeds in urging all of its members and the Chamber of Commerce from challenging the new law, as it relates to the immediate coverage of pre-existing conditions for children. Should any member of the insurance industry move forward in challenging this small but important provision, they are gambling on the fact that their increased profits will outweigh the damage that will be done to their reputation. Children and newborns with special health care needs and disabilities are not trying to take advantage of the system. They are not looking for a government handout.

Rather, these are individuals who need special care to continue to live. Instead of parsing the language of the law to deny them coverage, insurance practices should be quickly revised to meet the intent of Congress without delay.

Cross posted from the Peaceful Revolution column at the Huffington Post.  A Peaceful Revolution is a blog about innovative ideas to strengthen America's families through public policies, business practices, and cultural change. Done in collaboration with, read a new post here each week.

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