Pre-Existing Condition Regulations: A Civics Lesson

02 Aug

President Obama and others were quick to highlight that when health reform was passed, insurers would no longer be able to deny anyone coverage because they happened to have a pre-existing condition. That was one of those individual elements of health reform that was easy to communicate to the public, and that had a high degree of support among pretty much everybody but the insurance companies. Even the staunchest of conservatives wasn’t about to go on television and say “If you’re unlucky enough to have cancer, too bad. No insurance for you.”

Now, I could–and probably have, though memory fails me–focus on the implications of that provision, which takes effect for children under 19 beginning in September, and rolls out for everyone else in 2014, but instead, I just wanted to offer up a little lesson in how the law works. People are generally familiar with the “Schoolhouse Rock” version of how a bill becomes a law–but far fewer people understand what happens after the President signs the bill into law.

In a nutshell, the law that Congress passes and the President signs grants broad authority to the executive branch to create regulations. In the case of health reform, most of this authority is granted to the Secretary of Health and Human Services. If you look at the full text of the law, you’ll see a lot of sections that begin with phrases like: “The Secretary is authorized to…”, “The Secretary shall…”, and so forth.

In the Affordable Care Act, it is written that “a group health plan and a health insurance issuer offering group or individual health insurance coverage may not impose any preexisting condition exclusion with respect to such plan or coverage.” Of course, there’s more than that, including a section directing the Secretary to oversee the drafting of regulations relating to this aspect of the law.

Well, those regulations just got published in the Federal Register. You can read them here, if you’re interested. The point I want to make, though, is that what was essentially a single sentence in the health care law, has now been detailed in 21 pages of federal regulations that spell out precisely what can or cannot be done. And, of course, these regulations can be amended. So, you see, passing the law is only the beginning. Drafting the regulations is where the most action is.

For those of you who knew all of this already, forgive me for a remedial post, and just go read the regs. But it has been my experience that many people do not know such things, and I think that they deserve to. Consider it my community service for the week.


Posted by on August 2, 2010 in Uncategorized


2 responses to “Pre-Existing Condition Regulations: A Civics Lesson

  1. Anonymous

    August 8, 2010 at 12:45 pm

    Thanks for the info! You'd think if politicians were really serious, they'd leave fewer loopholes. Sounds like a lot could be added/removed based on who's in power. (e.g., if to many loopholes – one party could undo many things – or another party go way beyond the original intent. In effect, the regulators end up with more power than the Congress.On the lighter side… my wife was denied coverage for some "procedures" due to pre-existing condition. She became pregnant AFTER the coverage started. Go figure…

  2. Erina

    October 15, 2010 at 12:04 am

    The Georgetown University Center for Children and Families is conducting a survey that will help policymakers understand how health reform is impacting the health care coverage of children and young adults. If you know someone whose child was denied health insurance coverage due to a pre-existing condition or had a pre-existing condition excluded from coverage, or has an under 26 year old child who is uninsured, please ask them to take this quick survey


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s

%d bloggers like this: