Sebelius to Insurers: Cover Children's Pre-Existing Conditions

March 31, 2010— -- Days after President Obama signed the Patient Protection and Affordable Care Act, the Department of Health and Human Services had harsh words for some insurance companies and their treatment of children.

HHS Secretary Kathleen Sebelius pointed to "recent media accounts" that some health insurance companies planned to only cover pre-existing conditions if a child already has health insurance when guaranteed coverage for children begins in September. (Adults will have to wait until 2014 to be guaranteed insurance coverage regardless of any pre-existing conditions.)

For children with pre-existing conditions but no health insurance, Sebelius said she worried that health insurers thought they weren't obligated to provide insurance at all. Some have debated the meaning of the provision since it was signed last week.

"The American people debated and discussed health insurance reform for more than a year… Now is not the time to search for non-existent loopholes that preserve a broken system," Sebelius wrote Monday in a letter to the president of America's Health Insurance Plans (AHIP). Sebelius also said she will issue regulations to make sure insurance companies obey the more-inclusionary language of the law.

Karen Ignagni, president of AHIP, replied that "we await and will fully comply with regulations consistent with the principles described in your letter."

HHS spokesman Nicholas Papas said the story of Houston Tracy, now 16 days old and about to leave the hospital, "would be helped by the new provision."

Houston Tracy has already survived a rare birth defect, a feeding tube and open heart surgery. His family is still waiting to see how its battle for insurance coverage will come out.

Last week, Houston's parents found out that the term "pre-existing condition" can apply the moment someone is born.

"When he came out, he made one little cry and he didn't really cry much," said Houston's father, Doug Tracy, 39, of Crowley, Texas.

Tracy cut the umbilical cord and watched the hospital staff clean his son. But before his wife Kim, 36, could even touch their newborn son, doctors got worried.

"We could tell there was something wrong by the way they [the doctors] were acting," Doug Tracy said.

Houston's skin wasn't turning a shade of pink like most newborns because, somehow, his blood wasn't getting enough oxygen. Doctors rushed Houston, with Tracy riding by his side, in an ambulance to Cook Children's Medical Center in Fort Worth, Texas.

Within hours the Tracy family would learn their son was born with a heart condition called d-transposition of the great arteries, meaning the aorta and pulmonary artery are transposed where they should meet the heart. Doctors wanted to operate within days to save his life.

"In Houston's case he would not have survived had he not gotten the care," said Dr. Steve Muyskens, pediatric cardiologist at Cook Children's Medical Center, who treated Houston. "Most children with this [would] have a demise within days to months in life."

Muyskens explained that with the aorta and pulmonary artery switched, the system creates two separate pools of blood -- a small amount that travels from the heart to the lungs and back to the heart and another pool of blood that travels from the body to the heart and back out without ever reaching the lungs for oxygen.

"The red blood just circles on one side and blue blood circles on the other," Muyskens said. All of Houston's organs, including his heart, would soon die without red, oxygenated blood.

Even if doctors could stabilize a child with Houston's heart condition they would only have a short window to operate.