1. National: Record Number of Insured Children A record number of children have health insurance in the United States today, administration officials told a Senate panel, despite the recession. While 10 percent of children were without health insurance in 2008, Cecilia Rouse of the Council of Economic Advisers told the health panel's Subcommittee on Children and Families, that number may have dropped as low as 8.2 percent a year later--"the lowest level on record." "It is important to highlight one indicator of child well-being that thanks to the federal government has not suffered during the recession--health insurance for children," Rouse said in prepared remarks at a hearing on the "State of the American Child." "Given that over one-half of Americans obtain health insurance through their employer, hard economic times can bring increases in the numbers of children without health insurance coverage. Fortunately, the increase in the proportion of children covered by public health insurance more than compensated for the decline in private insurance." Rouse went on to credit the "historic expansion of the Children's Health Insurance Program" signed into law last year that extended coverage to an extra 2.6 million children during FY 2009. [Julian Pecquet, The Hill HealthWatch, 07/29/10] 2. National: Individual Market Insurers Need Not Enroll Kids All Year The Department of Health and Human Services (HHS) issued a clarification Tuesday of its rules requiring insurers in the individual market to accept children with pre-existing medical conditions, saying they would not have to offer insurance at all times during the year. The statement--inserted in the "questions and answers" section on an HHS web site devoted to the rules--follows comments last week by some state insurance commissioners that insurers were dropping kids-only health insurance because of worries about "adverse selection." Commissioners said parents could simply wait until children get sick to buy health insurance and then stop paying for it after they got well, leaving insurers without premiums from good risks to balance out the costs of medical payouts for sick children. "To address concerns over adverse selection, issuers in the individual market may restrict enrollment of children under 19, whether in family or individual coverage, to specific open enrollment periods if allowed under State law," the web site says. "This is not precluded by the new regulations." "For example, an insurance company could set the start of its policy year for January 1 and allow an annual open enrollment period from December 1 to December 31 each year. A different company could allow quarterly open enrollment periods. Both situations assume that there are no state laws that set the timing and duration of open enrollment periods." Scott Serota, chief executive of the Blue Cross and Blue Shield Association, hailed the clarification. He said in a news release that "we have been working closely with the administration to identify potential problems and seek solutions to ensure smooth implementation of the new healthcare reform law. Today's clarification is a good example of how we can successfully implement the new law by working together." [John Reichard, CQ HealthBeat, 07/28/10] 3. Utah: Help Is On The Way for Families with Sick (Or Recovering) Kids Thanks to an early provision in the federal health reform law that goes into effect this fall, Utah families with sick kids will soon be able to purchase previously unattainable private health coverage. Under the new rules, insurers can no longer deny children coverage or sell policies that exclude benefits for their pre-existing health conditions. That's good news for Utah families who don't have access to job-based coverage and the estimated 50,000 kids in our state with pre-existing conditions--a category that can range from relatively manageable chronic diseases to terminal cancer. Insurers' practice of avoiding children who may be "risky" from an underwriting standpoint forces kids to go without coverage and pushes families into our already overburdened safety net. Take for example the Bott family of Orem. Ryan Bott is self-employed and therefore does not enjoy the protections extended to employees of small and large businesses who are guaranteed insurance coverage under current market rules. When the Botts' son, Raydn, was born with a minor cleft palate defect they soon learned that he'd be classified as uninsurable by health insurers, potentially for the rest of his life. After Raydn had completed the necessary surgeries to correct his birth defect, he grew into a healthy toddler requiring few subsequent health care services beyond what a child his age typically requires. But the unlucky beginning to Raydn's life continued to haunt him when it came to acquiring private health insurance. Over a six-year period he was rejected by several carriers and eventually referred to the state's high-risk pool. The Knight family, also of Orem, has a similar story. When the Knights left their jobs to start a small business they sought an individual policy for their teenage daughter. They were shocked when their daughter was rejected by an insurer because her records indicated that she had used a pricey acne cream two years earlier. Like Raydn, she was also referred to the state's high-risk pool. Our high-risk pool should be a program for individuals who are truly too sick and too expensive to be served by the individual market, not for kids with minor or fully resolved health conditions. High-risk pool users typically incur large health expenses, which is why premiums in that program are so expensive, as the Botts found out. Health insurance for their son would run between $400 and $500 per month, on top of the amount they already paid to insure the rest of the family through a separate policy--not an affordable option. Ultimately, the Botts had no choice but to limit their income so that Raydn could qualify for the Children's Health Insurance Program, coverage jointly paid for by the state and federal governments. State legislators often complain about the cost and over-use of health insurance programs that provide a safety net to Utah families. But they sometimes fail to see the connection between the inadequacies of the private market and the need for these programs as the Botts' case illustrates. Come September, things should get much better for the Botts and the thousands of additional Utah kids with pre-existing conditions. At that time, insurers can no longer deny children health insurance or sell policies that exclude benefits for their pre-existing conditions. This change should help Utah families like the Botts get and keep the private health insurance they need without having to scale back a small business or buy into a high-risk pool designed for the catastrophically ill. Beginning in 2014, the Botts will also benefit from new health insurance standards that improve the quality of policies sold on the individual market and subsidies that will help make private coverage more affordable to Utah families. Taken together, these changes will help children like Raydn get the health coverage they deserve--kids who can sometimes beat an unlucky hand they've been dealt and who should be rewarded, not penalized, for that wonderful accomplishment. [Korey Capozza, Salt Lake Tribune, 07/09/10]