Decision of Health Insurers to Drop Children's Coverage

Author: National Patient Advocate Foundation
Published: 2010/10/07 - Updated: 2025/02/24
Publication Type: Informative
Topic: Disability Insurance - Publications List

Page Content: Synopsis - Introduction - Main - Insights, Updates

Synopsis: NPAF concerned over insurers discontinuing child-only plans, denying coverage to children with pre-existing conditions and undermining healthcare reform efforts.

Why it matters: This report from the National Patient Advocate Foundation (NPAF) addresses the concerning trend of certain health insurers in four states discontinuing "child-only" insurance plans just as new healthcare reform rules prohibiting discrimination against children with pre-existing conditions were set to take effect. The NPAF highlights that approximately 133 million Americans, including 20% of school-aged children, live with chronic illnesses and are at risk of facing health insurance discrimination due to their health status. The report emphasizes the importance of insurers upholding their commitments to eliminate pre-existing condition exclusions and urges collaborative efforts to ensure that vulnerable children have access to necessary healthcare coverage - Disabled World (DW).

Introduction

The National Patient Advocate Foundation (NPAF) is deeply disappointed and greatly concerned over the recent declaration of certain health insurers in four states to stop selling "child only" insurance plans only days before the new healthcare reform rules barring discrimination against children with preexisting conditions went into effect.

Main Item

Approximately 133 million Americans, or 45 percent of the population, suffer from a chronic illness, and 20 percent of those are school-aged children. All of these children were at risk of facing health insurance discrimination due to their health status. The new, historic healthcare reform legislation passed by Congress forbids insurers from turning down children with pre-existing conditions, but these recent actions by certain insurers appear designed to circumvent this important reform.

Months ago, NPAF was encouraged by the collaborative process that brought comprehensive healthcare reform to America. At that time, health insurers made a commitment to eliminate pre-existing conditions, but now many appear to be retracting that commitment and abandoning American families and children. In March, Karen Ignani, President and CEO of America's Health Insurance Plans (AHIP) wrote to the Secretary of Health and Human Services to say:

"With respect to the provisions related to coverage for children, we await and will fully comply with regulations consistent with the principles described in your letter."

On behalf of the patients served by PAF, we urge AHIP to work with their plan members and the Secretary to find a solution to this crisis affecting the youngest, least powerful and most vulnerable in our population. NPAF further encourages Congress to take action to enforce the clear intent of this legislation, which provided fair incentives for insurance plans to accept children with preexisting conditions.

Four percent of the patients assisted by Patient Advocate Foundation (PAF), NPAF's companion organization, are children.

In one example, a young family contacted PAF regarding an access to care issue as a result of a denied individual insurance policy. After an emergency room visit as a result of breathing trouble, the 16 year old patient was diagnosed with Supra Ventricular Tachycardia (SVT), a heart rhythm disorder. The insurance policy determined the symptoms of SVT were previously present and denied all claims associated with an emergency room visit and all follow up needs, including surgery, due to a pre-existing condition. After the diagnosis, the patient's mother was forced to seek employment with a hospital that offered insurance without a pre-existing clause, securing access to a necessary $50,000 surgical procedure for her son. If the patient had access to coverage at the time he was diagnosed, he wouldn't have needed to wait for his surgical procedure that ultimately allowed him the ability to return to normal activity.

National Patient Advocate Foundation (NPAF)

NPAF and its companion organization, the Patient Advocate Foundation (PAF), were established in 1996 on the principle that health care is a basic human need and shared social responsibility. NPAF CEO and President, Nancy Davenport-Ennis stated: "We encourage these health insurers to reconsider and to find ways to extend coverage, regardless of prior or current health status, in order to assist the millions of parents across the United States who are struggling to provide healthcare for their children faced with chronic disease conditions."

Insights, Analysis, and Developments

The recent actions by some insurers to withdraw "child-only" policies undermine the progress intended by healthcare reforms designed to protect children with pre-existing conditions. This development not only jeopardizes the health and well-being of affected children but also places additional financial and emotional burdens on families striving to secure essential medical care for their loved ones. It is imperative that policymakers and insurance providers work together to address this issue, ensuring that all children, regardless of their health status, have equitable access to comprehensive health insurance coverage

Attribution/Source(s): This quality-reviewed publication was selected for publishing by the editors of Disabled World (DW) due to its relevance to the disability community. Originally authored by National Patient Advocate Foundation and published on 2010/10/07, this content may have been edited for style, clarity, or brevity. For further details or clarifications, National Patient Advocate Foundation can be contacted at npaf.org NOTE: Disabled World does not provide any warranties or endorsements related to this article.