Battle of the Titans: Big Kids 1, Big Insurance 0

By Eddie Griffin

Wednesday, March 31, 2010

Born March 15, 2010, Houston Tracy needed immediate heart surgery to correct a defect known as “Blue Baby syndrome”. But the insurance company refused to provide the baby coverage based upon this “pre-existing” condition.

According to a Star-Telegram report:

Doug and Kim Tracy are self-employed, but cannot afford to carry insurance on themselves. They provide healthcare coverage for their two children under Blue Cross Blue Shield of Texas. It was under this existing policy that they hoped to include Houston. Otherwise, they paid for prenatal care and hospitalization out of their pockets

Doug Tracy called the insurance company before the baby's birth to get the child covered but was told by an insurance representative that he had 30 days after the birth to apply for a policy. Then the baby was born with the defect and the insurance company denied his coverage, leaving the family to potentially deal with the expensive cost of the operation.

“How can he have a pre-existing condition if the baby didn't exist until now?” Tracy asked.

This was one of the very issues that shaped the long and arduous healthcare debate, whether children with pre-existing conditions would receive coverage under the new legislation. So Doug took his cause to the public, on Facebook, to the media, and congressional leaders.

Blue Cross Blue Shield of Texas responded by courier.

After the denial of coverage, friends rallied around the family and contacted politicians and the media to publicize the situation. State Rep. Chris Turner, D-Arlington, and Sen. Wendy Davis, D-Fort Worth, asked Blue Cross to reconsider its decision. Turner said that it was great news that the medical bills would be covered.

(See Wendy Davis)

In the meantime, Health and Human Services Secretary Kathleen Sebelius issued a sternly worded message to the insurance industry not to try and exploit a potential loophole in the new law that would allow them to deny healthcare coverage to children like Houston Tracy.

“Health insurance reform is designed to prevent any child from being denied coverage because he or she has a pre-existing condition,” Sebelius wrote to Karen Ignagni, president of America's Health Insurance Plans. “Now is not the time to search for nonexistent loopholes that preserve a broken system.”

“The term 'pre-existing condition exclusion' applies to both a child's access to a plan and his or her benefits once he or she is in the plan,” Sebelius wrote.

Narrowly read, it seemed to say that if an insurance company accepts a particular child, it cannot write a policy for a child that excludes coverage for a given condition. For example, if the child has asthma, the insurer cannot exclude inhalers and respiratory care from coverage, as sometimes happens now.

“Health plans recognize the significant hardship that a family faces when they are unable to obtain coverage for a child with a pre-existing condition, Ignagni said in a response letter to Sebelius. The industry will “fully comply” with the regulations.

KIDS 1, Big Insurance 0

But U.S. Congressman Michael C. Burgess and Texas Attorney General Gregg Abbott would have this victory short lived, because they seek to invalidate the healthcare law by constitutional challenge, and thereby undo the law and consequently uncover every “blue baby that comes into the world”, and genetically deformed babies being uncovered because of a “pre-existing” condition.

A pre-existing condition can date back to the at-risk mother, obese or diabetic, and cancer risk that run in the family. It was totally at the discretion of Big Insurance, to determine condition of coverage, and prices. Now that dominance is no more.

Burgess and Abbot seek to turn back the clock, and undo the good already done. (See Burgess FOX interview). The health insurance companies can undo all policies with “pre-existing” conditions like Houston Tracy.

AG Gregg Abbott issued this press release through Cox Newspapers, “Texas attorney general discusses multistate healthcare lawsuit”.

(Ref. http://www.star-telegram.com/2010/03/30/2078726/texas-attorney-general-discusses.html)

AUSTIN -- Texas Attorney General Greg Abbott and 12 attorneys general from other states have sued in a Florida federal court to block implementation of the healthcare legislation that President Barack Obama signed into law last week.

[Excerpt]
Did you feel compelled to seek permission to do this from Gov. Rick Perry or members of the Legislature?

Whenever the sovereignty of a state has been encroached upon by the federal government, as it has been in this situation, it is the inherent right of the attorney general to represent the state of Texas. But that aside, I had been in consultation with Gov. Perry and his office -- my office had been working with his office -- before this lawsuit was filed.

EDDIE GRIFFIN: Response- False. By what “inherent right” does the Attorney General assume authority under the Texas Constitution? State’s Rights vs. Human Rights is the issue.

Will this require a lot of staff time, and how much will it cost?
There has been no out-of-pocket cost incurred by the state of Texas. Those costs have been borne by Florida, as I understand it. Of course, we do have some printer costs and some copier costs involved. Staff time -- we haven't hired new people; we won't need to hire new people; we won't be hiring any experts. So it won't cost a dime of taxpayer dollars with regard to any out-of-pocket costs.

There have been some hours spent by some people already on staff who are working on a multitude of other issues, but this is just in the ordinary course of their activities. Most of the work is actually going to be conducted by Florida. While this may not be costing hardly anything to the taxpayers of the state of Texas, the potential of saving taxpayer dollars is immense.

EDDIE GRIFFIN: Response- False. There is a people’s interest that supersedes state’s rights, and that is The Right to Life, which will be undone if the AG prevails.