What's Working

Risky Business
Child Advocates, Insurers Compromise to Cover Kids

  What's Working - Winter 2012 - Risky Business

Maria Serrano (shown here with her father, Toby Serrano) is no longer among Colorado's uninsured population thanks to coverage through the CHP+ program.

By Rebecca Jones
Photography by Barry Staver

A year ago, Denver auto mechanic Toby Serrano couldn't buy health insurance for his daughter Maria. Not at any price.

Though the high school honor student is healthy and thriving, she was born with a blood vessel malformation that required 26 operations when she was a toddler. Insurance paid for everything, but when Maria was 9, Serrano changed jobs and his family lost their employer-sponsored insurance coverage. No new carrier would agree to insure Maria. She has been among the thousands of uninsured Coloradans ever since.

"Just like any child, sometimes she gets sick," Serrano says. "And every time that happens, the money comes straight out of my pocket."

For decades, insurance companies selling individual health plans – in Colorado and other states – were able to deny coverage to a person because of medical history. Then, in September 2010, a provision in the federal Affordable Care Act (ACA) took effect prohibiting insurers from denying coverage to children who have health issues. The ACA will extend that protection to adults with health issues in 2014.

It seemed like Maria's insurance problem was solved. But even before the provision took place, major health plans began announcing they would no longer offer child-only plans since they couldn't exclude some children – such as Maria – whose care might be costly. Advocates for children's health, including All Kids Covered, were alarmed.

Since 2006, All Kids Covered, a nonpartisan coalition of nearly 40 statewide organizations, has worked with policymakers, service providers and other groups to reduce the number of Colorado children who lack access to health care because they are uninsured.

In October 2010, Cody Belzley, vice president of Health Initiatives for the Colorado Children's Campaign, a lead partner in All Kids Covered, contacted the Colorado Association of Health Plans to craft bipartisan legislation to address the issue. The resulting legislation, Senate Bill 128, was passed by the Colorado Legislature and was signed into law on April 29, 2011.

The law requires all insurance companies that do business in Colorado to offer a child-only plan – open even to children with medical histories that make them bad risks for insurers. In exchange, limited yearly enrollment periods for these policies were set up, so families couldn't just wait until they actually needed the coverage before buying it.

"Insurers had a valid concern," Belzley says. "They said, 'If you force us to sell a product without forcing families to buy it, they will make the rational decision to wait until they need it.'" By limiting the enrollment period to two months, twice a year, families can't wait until a child gets sick before signing up.

"It would be very unusual for health plans – [which] over the last decade have so often been in the position of saying mandates are a bad thing – to say, 'We need this mandate,'" says Ben Price, executive director of the Colorado Association of Health Plans. "We needed All Kids Covered to be there to also say that kids really need this as well."

The changes in the law didn't end Maria Serrano's access issues. The family found a child-only policy, but at roughly $500 a month, it was cost-prohibitive for the Serranos.

"I've always been in the financial position where I made too much for any government assistance, but I don't make enough to spend thousands of dollars on insurance," he says.

When the family's finances slipped further, Serrano was able to qualify Maria for the Child Health Plan Plus (CHP+), a state program that covers more than 64,000 lower-income Colorado children whose families make too much for Medicaid. Serrano can thank All Kids Covered for that, too. The coalition has routinely pressed for expansion of the CHP+ program.

"We're proud to be a part of All Kids Covered," Belzley says. "It's a group of people who care about kids and who are committed to extending coverage to all children."