Child advocates slam HHS open-enrollment guideline

Children’s welfare advocates are pushing back this week against new rules that will restrict child enrollment in health plans.

The guidelines, issued Tuesday by the Health and Human Services Department (HHS), will allow private insurers to deny children trying to enroll in coverage outside of specified open enrollment periods.

“Despite record profits, insurance companies are using America’s children as a pawn to further their bottom lines,” Bruce Lesley, president of First Focus, a child-welfare group, charged in a statement. The guideline, which will inevitably leave children uninsured, highlights the need for continued support of the safety-net programs — namely Medicaid and the Children’s Health Insurance Program (CHIP) — where those children will likely land, Lesley added.

“This threat is a clear illustration that children, particularly those with special health care needs, must have strong governmental protections and oversight, to ensure they receive the health care they need to grow and thrive,” he said.

The Democrats’ new healthcare reform law takes steps to eliminate restrictions on children’s health insurance, prohibiting insurers from denying coverage to children with pre-existing conditions. 

Many private insurers, however, said the provision would simply discourage parents from enrolling healthy children. The companies were threatening to drop their “kids-only” plans unless the administration put some restrictions on enrollment.

On Tuesday, HHS complied.

“To address concerns over adverse selection, issuers in the individual market may restrict enrollment of children under 19, whether in family or individual coverage, to specific open enrollment periods if allowed under State law,” the agency clarified. “This is not precluded by the new regulations.”

Translation: Insurers can continue to deny coverage to sick children when parents try to enroll them outside of yet-to-be-established open enrollment windows.

The children’s groups don’t like what they see. 

“The health of our children is more important than the bottom line of health insurance companies,” Lesley said. 

“Continued action and vigilance must be taken in order to ensure that children reap the benefits and promise of health reform, including protections from current private insurance market practices that deny coverage to children with pre-existing conditions.”

The scaled-back prohibition on denying coverage to sick children goes into effect Sept. 23.