1. Hawaii: Outreach and Enrollment Success Stories Hawaii Covering Kids compiled interesting stories about some families who were helped through its recent postcard outreach and enrollment activity. Click on this link to read the PDF file. Please visit our Facebook page for more updates and while you are there Become a Fan! 2. Texas: Under Fire, Baby's Medical Expenses Covered by Health Insurance Houston has health insurance. The news, announced on a web site set up for the Crowley baby, ended his family's week-long fight after the newborn was denied health insurance because he needed surgery to repair a heart defect--what the health insurance company called a pre-existing condition. Doug and Kim Tracy's battle with Blue Cross Blue Shield of Texas garnered national attention, coming on the heels of historic healthcare legislation, signed by President Barack Obama a week ago, which will require health insurance companies to cover pre-existing conditions. The Star-Telegram reported on the Tracys' problem on Friday. That evening, Darren Rodgers, president of Blue Cross Blue Shield of Texas, personally contacted the family. Initially he offered to see whether coverage through the Texas Health Insurance Risk Pool could be backdated to the baby's birth, Tracy said. But when that was not possible, he offered to work with Cook Children's Medical Center to pay for Houston's medical care. On Monday, a letter outlining the offer was sent by courier to the Tracy home. Blue Cross Blue Shield agreed to pay the baby's medical expenses from his birth on March 15 through March 26, when coverage through the risk pool took effect. Houston's surgery took place on March 19. "I feel like Blue Cross Blue Shield finally realized they made a mistake and did come through for me," said Tracy, 39. "I am happy this is taken care of and my little boy is going to be fine." Privacy laws prevent Blue Cross Blue Shield of Texas from commenting on individual situations, said Margaret Jarvis, a company representative. "We understand what an emotional time this is for the Tracy family and we regret the frustration they are feeling," a statement from the company reads. "What we can tell you is that we've responded to Mr. Tracy in writing over the weekend and are pleased to report that we've proposed a solution that addresses his and his family's concerns." Tracy said that coverage his son will get through the Texas Health Insurance Risk Pool will cost only $10 more than the policy that he was denied. Doug and Kim Tracy do not carry health insurance on themselves, but they do cover their two other children and planned to add Houston. The couple said that they are self-employed and find insurance for themselves too expensive. She owns a beauty salon and he owns Burleson Scuba and Paintball. They paid for prenatal care and hospitalization out of their pockets. Tracy said he called Blue Cross Blue Shield of Texas before the baby's birth to get the child covered but was told by an insurance representative that he had 30 days after the birth to apply for a policy. Then the baby was born with the defect. After the denial of coverage, friends rallied around the family and contacted politicians and the media to publicize the situation. State Rep. Chris Turner, D-Arlington, and Sen. Wendy Davis, D-Fort Worth, asked Blue Cross to reconsider its decision. Turner said that it was great news that the medical bills would be covered. "I commend Doug and Kim for their tenacity in fighting for their son, and am grateful to have had the opportunity to help in this situation," the statement read. Doug Tracy said he appreciates all the support his family received. Friends used Facebook and other outlets to garner national attention for the story, which Tracy said put a lot of pressure on Blue Cross Blue Shield. "I think they realized this is not going to go away," Tracy said. Blue Cross Blue Shield would not say what prompted its decision, citing privacy laws. The issue is sensitive, Jarvis said, but the company is committed to providing affordable health insurance whenever possible. Tracy said that the money that people raised through benefit concerts and contributed to a fund to pay for Houston's medical bills will be donated to Cook Children's Health Foundation. The Tracy family is an example of a pervading philanthropic spirit that exists at Cook Children's, said Gary Cole, vice president for development for Cook Children's. "In a time of personal need, this family is seeking ways to help others," he said. "This is the truest form of philanthropy, and we are most grateful for such acts of kindness and concern for our patients." [Jan Jarvis, Ft. Worth Star-Telegram, 03/30/10] 3. Utah: The Kids Won Much of the health care reform news this past week has focused on political winners and losers. But parents are more concerned with their own families than with political box scores. And let's be clear: The reform plan passed by Congress is a major victory for Utah's children and families. This health care reform puts doctors in charge by requiring insurance companies to provide pediatrician-recommended care. It continues the Children's Health Insurance Program, which works with Medicaid to cover nearly 170,000 Utah kids, and it strengthens Medicaid so that kids and parents can be covered together. It gives middle-class families real bargaining power through health insurance exchanges, and it offers tax credits to those who need extra help. And, starting right away for children with insurance, it ends insurance companies' discrimination based on pre-existing conditions. Health care reform delivers what families need: affordable, reliable health care coverage that won't disappear if they lose a job or get sick. Thanks to CHIP and Medicaid, most of Utah's uninsured children can be insured right now, if we can find and enroll them. Let's work together and make Utah kids the first winners in health care reform. [Karen Crompton, Salt Lake Tribune, 03/31/10] 4. National: Flap About Children's Health Insurance Settled Insurers said they would comply with regulations the government issues requiring them to cover children with pre-existing conditions, after a dispute with lawmakers over interpretation of the new health care legislation. The Obama administration has made near-immediate coverage for sick children a priority in its health care overhaul. But shortly after the bill's passage last week, insurers contended that the law didn't require them to accept sick children until 2014. The insurance industry's lobby, America's Health Insurance Plans, said the law meant only that they needed to cover treatments for sick children who already were customers. Kathleen Sebelius, secretary of Health and Human Services, sent AHIP president Karen Ignagni a letter Monday pledging to issue new regulations in coming weeks to clarify that insurers must give sick children access to their parents' plans starting in September. "Now is not the time to search for nonexistent loopholes that preserve a broken system," Ms. Sebelius said. AHIP said delinking the requirement to insure sick children from the law's mandate that everyone buy health insurance, which goes into effect in 2014, could drive up prices in the meantime. But the group said it would do whatever HHS tells it to do. In a letter responding to Ms. Sebelius Monday, Ms. Ignagi said her members recognized the "significant hardship that a family faces when they are unable to obtain health insurance for a child with a pre-existing condition," and pledged to fully comply with the regulations HHS is developing. The group is analyzing how much it would cost to take all comers under 19 years old. The industry group said it would comply with the broader interpretation after lawmakers expressed outrage over its narrower reading. "Any attempts to create loopholes at the expense of children's health care are reprehensible and those who wish to take such action will have to answer for it," said Sen. John D. Rockefeller IV (D., W.Va.). First Focus, an advocacy group for children, said the bill's intent was to protect children with pre-existing health conditions from being denied health insurance. Bruce Lesley, the group's president, said it was "disappointing that insurance companies continue to look for opportunities to deny coverage to this vulnerable population." Though sicker children incur more health expenditures, additional costs to the industry were likely to be minimal as the number of children who would be affected by the broadest interpretation of the law could be relatively small. The Children's Health Insurance Program (CHIP) is credited with extending coverage to about eight million low-income children who are not poor enough for Medicaid. Roughly eight million children remain uninsured, according to the Kaiser Family Foundation, but just 1% to 2%--or 80,000 to 160,000--have a health condition such as cystic fibrosis or cancer that would disqualify them from private insurance coverage, said Sara Rosenbaum, chairwoman of the health policy department at George Washington University and a children's health care expert. Many of those children's families were unaware they could qualify for Medicaid or CHIP assistance or enroll in an employer plan, she said. "We're talking nationwide about a handful of children" who might benefit from expanded private coverage, Ms. Rosenbaum said. "I can't imagine why insurance companies are fighting this so hard." Insurer practices regarding pre-existing conditions vary, but companies tend to exclude coverage for childhood illnesses such as juvenile diabetes. Jade Harmer, 13, of Fredericksburg, Va., might be able to benefit from the health bill's immediate provisions. Her mother, Tina Harmer, said the family's health insurance, a Blue Cross Blue Shield plan that is part of the Federal Employee Health Benefits Program, wouldn't cover weekly $1,000 drug injections for Jade's multiple sclerosis. The Blue Cross Blue Shield Association, which administers the Harmers' plan, couldn't comment on the specifics of the case. But Jena Estes, a vice president there, said the drug in question was not approved for use in children. Ms. Harmer applied to several other insurers but said her daughter was turned down because of her health condition. She was hoping that with the new health-care bill she could find a policy that would cover her daughter's treatment. "I've been keeping a close eye on health reform because I know it would help with pre-existing conditions, but a few things worry me," said Ms. Harmer. "Is it what they say it is?" [Avery Johnson, Wall Street Journal, 03/30/10]