Insurer executives, congressional staffers, lobbyists, lawyers, consumer activists and others are starting to pore over the Patient Protection and Affordable Care Act of Congress and a sister measure.
The New York Times today ran an article about a conflict between insurance industry experts and Democratic policymakers over the precise meaning of a section dealing with health coverage for children with health problems.
William Schiffbauer, a Washington lawyer who represents health insurers and is quoted in the Times article and other articles about the conflict, says he believes that the contentious process that produced PPACA and H.R. 4872, the PPACA “fixer bill, means that the controversy over the child preexisting condition exclusion provision is just one of many worms that careful readers of the legislation will dig up.
In legislative language, “the change of a semicolon or a colon or a period can make a substantial difference,” Schiffbauer says — and PPACA and H.R. 4872 contain more than 2,000 pages of letters, numbers and punctuation marks.
What Your Peers Are Reading
In the Times article, Robert Pear writes about a PPACA provision that prohibits health insurers from imposing preexisting conditions exclusions on children.
America’s Health Insurance Plans, Washington, believes “the legislation that was enacted prohibits pre-existing condition exclusions for children starting in 6 months, and requires guaranteed coverage for children and adults starting in 2014,” according to AHIP spokesman Robert Zirkelbach.
Policymakers at consumer groups, on Capitol Hill, and in the Obama administration say health insurers are finding ambiguity where none exists.
Health insurers should stop searching for “non-existent loopholes,” U.S. Health and Human Secretary Kathleen Sebelius has written in a letter to Karen Ignagni, president of America’s Health Insurance Plans, Washington. “I am preparing to issue regulations in the weeks ahead ensuring that the term ‘pre-existing condition exclusion’ applies to both a child’s access to plan and to his or her benefits once he or she is in the plan.”
From insurers’ point of view, Schiffbauer says, the bill language bans preexisting exclusions for health plan enrollees under 19 years of age but says nothing about whether the ban applies to applicants for coverage, or the pricing of coverage for children under 19 years of age who have health problems.
AHIP is trying to dispel fears that health insurers are eager to use loopholes to avoid providing health coverage for sick children.
“We understand policymakers are contemplating changes to the provisions related to coverage for children, and we will implement any revisions that are made,” Zirkelbach says.
AHIP itself proposed more than a year ago that Congress put a ban on pre-existing condition exclusions, require insurers to sell health coverage on a guaranteed issue basis, and require all Americans to have health coverage, to keep people from gaming the system by waiting until they are sick to pay for health coverage.