Is HHS Compromising with Insurers?

Jeff Elliott for HealthLeaders Media, October 20, 2010

Pardon the football analogy, but it's fall:

It's fourth and ten and the Department of Health and Human Services (HHS) is just out of field goal range. They've been driving hard to an end zone with the words "Affordable Care Act" painted in big letters, but with a comfortable lead and plenty of time on the clock, the smart thing to do is, of course, to punt.

That's exactly what HHS did with the ACA's current 800-pound gorilla: ensuring children with preexisting conditions can get healthcare coverage.

In an October 13 letter from Secretary Sebelius to the National Association of Insurance Commissioners (NAIC), HHS attempted to stem the recent trend among healthcare payers to drop "child only" health plans by clarifying policies that aren't explicitly forbidden by the Act.

Among those clarifications, HHS says insurers are within their rights to (if permitted by state laws):

  • Maintain separate "child-only" policies separate from closed policies;
  • Penalize members that drop coverage and subsequently reapply;
  • Set the number and length of open enrollment periods; and
  • Adjust rates based on members' health status.
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