Sunday, March 28, 2010

Some Health Insurers Seek To Catch The "Train To Hades" -- Express-Style!

So, apparently some lawyers for some health insurers are suggesting that -- despite what the Senate and House said was their collective intent, in passing the reform package -- the insurers may decide to argue they are not required to cover children with pre-existing conditions, this year. They would argue that they are allowed to drop the entire family, to avoid covering the sick child. They would argue that they would not be required to cover the sick child until 2014.

Here is what The New York Times is reporting, tonight -- as to legislative intent:

. . . .The authors of the law say they meant to ban all forms of discrimination against children with pre-existing conditions like asthma, diabetes, birth defects, orthopedic problems, leukemia, cystic fibrosis and sickle cell disease. The goal, they say, was to provide those youngsters with access to insurance and to a full range of benefits once they are in a health plan. . . .

The first place the courts will look, in deciding such a denial of coverage/dropped coverage case, will be the "plain language" of the statute. The next place the courts will look -- if the language is deemed ambiguous (which is what the insurance company lawyers are arguing), will be to seek out legislative intent. On that score, the isurers are likely to lose, given the above -- and given the about two-dozen speeches made by Congressional leaders, this past week, alone.

But just to be certain, a spokesperson for the White House now indicates that the Obama Administration plans to issue regulations setting forth its view that "the term 'pre-existing' applies to both a child’s access to a plan and his or her benefits once he or she is in a plan."

That ought to seal it -- except for that little matter of handing out an Express Pass to Hades to the insurers with the temerity to argue that they ought to be able to wriggle out of a clear intent to regulate/mandate coverage -- under a new federal legal scheme -- to stiff sick children, despite the intent of the legislative branch. Outrageous. Note that the insurers are not arguing the law is unconstitutional -- just that a term of art in arcane insurance industry practice wasn't expressly employed by Congress, to refer to these children.

If this is not the best evidence that reform is desperately needed, I don't know what is. Holy cow.

1 comment:

Condor said...

Well -- that's MORE like it.

[Insurers will follow the law, as enacted. Sheesh. That should NOT be a news item.]

Credit the White House, for this win.