Only months from their 65th birthdays and the switch from employer-offered health coverage to Medicare, Phillip and Diann Green of Forney realized they had a problem. After retirement, none of the state’s insurance companies will cover their 12-year-old granddaughter, Aria, whom they have raised since her infancy.
Insurers in Texas and across the nation — protesting a provision of the 2010 federal health care overhaul that prohibits pre-existing condition limitations for children under 19, have simply stopped offering new child-only policies. For children being raised by their grandparents, who are not poor enough to qualify for Medicaid and have no employer-offered insurance or family plans to cover them, there are few options.
No agency keeps track of how many children in Texas are affected by the elimination of child-only plans, but experts suggest it is in the thousands.
“Raising a child — finding her health insurance — it’s certainly not something you expect at our age,” said Mr. Green, who, with his wife, gained custody of Aria when she was 7 months old because her biological parents were ill prepared to raise her. “But everybody has come up with an excuse for not taking her.”
Jared Wolfe, executive director of the Texas Association of Health Plans, said it is not because insurers do not want to cover children. The federal health care overhaul, and in particular the pre-existing condition language, has been interpreted to mean that insurers must write a policy for any child who applies, Mr. Wolfe said. That effectively ensures that only sick children will apply for benefits, he said — an unworkable financial scenario for insurance companies.
“It’s a bad situation,” Mr. Wolfe said. The child-only plans “are a very small percentage of the market, but for those people, it means quite a bit.”
Some states have responded to these insurers with legislation. In Texas, Representative Garnet Coleman, Democrat of Houston, has filed a bill that would require insurers participating in the individual insurance market to accept applications from children under 19 — legislation that he said mirrors measures passed in California, Kentucky, New Hampshire and Washington.
“We have to correct the market to make sure children don’t go without coverage,” Mr. Coleman said. But with an overwhelming Republican majority in the State Legislature that both cannot stand the federal health care overhaul and believes that the child-only insurance market should work itself out, such a bill appears unlikely to pass.
“Time will tell whether there really is a problem or not,” said Representative John Zerwas, an anesthesiologist and Republican of Simonton. “If there’s a viable market for it, I would like for it to sustain itself.”
Mr. and Mrs. Green never thought that being retired and having health insurance for their granddaughter were mutually exclusive. As they approached 65, and the threshold for getting on Medicare, the federal health care plan for older Americans, they started making all the requisite inquiries to get Aria insured. But in call after call last fall, insurance companies operating in Texas told them they no longer offered new child-only policies — and acknowledged that the Greens had few choices.
The Greens’ income level means Aria, who has no pre-existing conditions, does not qualify for the joint state-federal Children’s Health Insurance Program, or CHIP. Nor can she apply for a high-risk pool, which experts say requires that a child have a pre-existing condition and receive a formal denial from a private insurance company. (When no plans are offered, insurers do not have to issue denials.)
For now, Aria — who is currently insured through Mrs. Green’s employer, Wal-Mart — only has one option, Mr. Green said: a Cobra plan that costs nearly $550 a month and lasts for only a year and a half.
Officials with the Texas Department of Insurance say that they are looking for ways to entice insurers into selling child-only plans.
Some providers say they are searching for a middle ground. Blue Cross Blue Shield of Texas, which stopped offering child-only coverage last fall, said it was seeking approval from the Department of Insurance for a new child-only policy that would have “benefits and rates appropriate to the new market requirements.”
Mr. Green said that when he called federal lawmakers about the matter, they told him it is a state issue; his state representatives told him he should approach the federal government.
“Everyone I talk to about this, their response is, ‘What would you like for us to do about this?’ ” said Mr. Green, who had to take early retirement from his job at the Unisys Corporation at age 50 after having a heart attack at 34 and a quadruple bypass at 42. “I just want them to fix it.”