Imagine this scenario: A child is born eight weeks early. His parents have no health insurance. The baby, they believed, would be covered immediately by insurance they hoped to purchase at the time of his birth. They need it, too; his early birth means a hospital stay, drugs to help his lungs grow, a spell in the NICU.
In Oklahoma, that would mean bankruptcy.
As of December 28, 2011, the state of Oklahoma has now mandated – mandated!– that babies from birth to one year old can now be excluded from health care coverage for families that purchase child-only health insurance plans. Yes, you read that right. This is an opt-out for insurance companies who offer child-only policies, a legal way for insurance companies to skip out on that crucial first year of a child’s life.
In all the strange machinations this country has seen around health insurance, the one thing that seemed most intuitively obvious is that the youngest among us should not be penalized; babies and children in this nation that “values life” should be protected in the cocoon of our care. Studies have shown that though we spend much more money and time on end-of-life care, we’d be better off, as a society, focusing on the under twos. And health insurance reform seemed to, at least partly, acknowledge that. As of September 2010 under the Affordable Health Care Act, no insurance carrier that covers children is allowed to exclude a child under the age of 19 for a pre-existing condition.
Sounds great, right? The problem is the secondary language: “plans that cover children can no longer exclude, limit, or deny coverage to your child under age 19 solely based on a health problem or disability that your child developed before you applied for coverage.” (Emphasis here is mine.) Though the intentions of those who drafted that text were noble, insurance companies interpreted the language against the grain of goodwill by deciding, all at once, simply not to be plans that cover children. That means parents who do not purchase insurance for themselves, but would purchase it for their kids cannot do so. Also affected are grandparents who qualify for Medicare, but want to purchase plans for grandchildren in their care.
Indeed in states across the country – including Alaska, Arizona, Connecticut, Delaware, Georgia, Minnesota, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Rhode Island, South Carolina, Tennessee, Utah, West Virginia and Wyoming — insurance companies simply stopped offering child-only insurance packages once they were told that the pre-existing condition clause would no longer apply to kids. And those were just the states where all the insurers backed out: In 39 states, at least one insurance company dropped kids-only coverage.
Insurance companies explained it was prohibitively expensive to cover children; most claimed only children with problems would be on the rolls. That’s not necessarily true though – while there will be some children with birth defects and other expensive needs, the majority of kids, especially in that early year of constant check-ups and vaccinations and growth progress assessment, are healthy, it is just that those check ups and vaccinations aren’t free.
The pool of those affected number (approximately) in the thousands — not overwhelming, but by no means insignificant. State by state, governments worked to reengage (and penalize) insurance companies who had backed out of kid-care, and woo them back towards child-only coverage plans. California told companies that dropped kids they would be dropped from working in the state for five years. Last April, Colorado passed a law making it mandatory for insurance companies to offer a child-only insurance option, Kentucky also reined in insurance companies, requiring those who had stopped offering child-only plans to reopen sales to child-only needing families. Washington state and New Hampshire also pulled their insurers into line.
But Oklahoma did not go in that direction. Governor Mary Fallin signed an emergency rule at the end of December 2011 that eliminates “birth” as a qualifying experience for insurance. (Explained well here and here.) State Insurance Commissioner John Doak’s office told press that dropping babies from birth to age one was the only way insurance companies offering child-only policies would agree to come back into the Oklahoma market.
The governor’s press flack blamed the president. “We think it will get more kids covered, said Alex Wentz, “it’s not perfect, but honestly we view it as cleaning up a mess made by the Obama administration.”
Wentz did not address the mess of what happens to paying for the care and vaccines kids need in year one. But more significantly – he did not address the problems that will confront families when children are born with problems that requiring immediate attention, from congenital heart defects to spina bifida.
Sarah Wildman is a columnist for the International Herald Tribune, a regular contributor to The New York Times, Slate and The Guardian, and a contributing editor at The Forward. Follow her on Twitter: @sarahawildman