The Patient Protection and Affordable Care Act (“PPACA”) signed by President Obama on March 23, 2010 is comprehensive heath reform intended to provide all Americans access to quality, affordable health care. PPACA made significant changes to the limitation on pre-existing condition restrictions on children. The Obama administration has made it very clear that this law was designed to prohibit discrimination against children with pre-existing conditions effective for plan years beginning six months after its enactment.

Despite the intent of the new law, some believe that new coverage to children may actually be denied based on a pre-existing medical problem. However, if a child is accepted for coverage, or is already covered, the insurer cannot exclude payment for treating a particular illness. If this interpretation is correct, full protection for children would not become effective until 2014, when insurance companies could no longer deny coverage to any person on account of health problems.

As a result of this debate, the Secretary of Health and Human Services issued a recent statement that the health insurance reform was designed to prevent any child from being denied coverage because of a pre-existing condition. To address any ambiguity, she plans to issue clarifying regulations in the weeks ahead. Even if the uncertainty is resolved, there is nothing that would prohibit insurers from charging higher rates to provide coverage for children with pre-existing conditions.

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