NJ Insurers Say They’ll Retain Some ACA Reforms However High Court Rules

Beth Fitzgerald | June 13, 2012 | Health Care
One of most popular provisions of ACA -- keeping kids on parents' health plans until they're 26 -- needn't be a constitutional casualty

Perhaps the least controversial provision of the Affordable Care Act is the one that requires health plans to cover children until age 26 — and it’s been especially popular in this tough economy, as young people struggle to find good jobs with health coverage. This month the Supreme Court will decide whether all or part of the ACA is unconstitutional, but at least two insurers operating in New Jersey, Aetna and UnitedHealthcare, will continue covering kids until age 26, regardless. Another two, Cigna and Horizon Blue Cross Blue Shield of New Jersey, are awaiting the court’s ruling before addressing the issue.

Michael McGuire, chief executive of UnitedHealthcare for New Jersey, said the company decided to allow parents to keep their kids on their health plans until age 26, whatever the Supreme Court rules, because, “We really just wanted to give people better certainty as to what potentially could happen. We don’t know what will happen at the Supreme Court, but we thought it was important that we said to our members: ‘No matter what the outcome here, there are certain things about the ACA that we think are important.’ We thought it was the right thing to do.”

UnitedHealthcare said it will retain other ACA reforms, including the elimination of co-pays for preventive services like annual check-ups, diabetes and blood pressure screenings, and vaccinations. The company said it does not impose lifetime dollar limits on how much it will pay on a policy, and that practice will continue. Regardless of the fate of the ACA, the company will continue to abide by the law’s ban on insurers seeking to rescind a policy, except in cases of fraud, and will abide by the legal requirement that members be given an independent appeal process when claims are denied.

Aetna said in a statement: “A number of provisions in the health reform law have been woven into the fabric of our healthcare system, bring value to customers and consumers, and should be maintained.” Thus, the company will continue covering dependents to age 26, provide 100 percent coverage for some preventive care, and provide an independent appeals process.

Horizon spokesman Thomas Vincz said the company “awaits the United States Supreme Court’s decision on the Affordable Care Act. Our primary goal is to best meet the needs of our members in providing access to high-quality, affordable healthcare. We will continue to work closely with all stakeholders to transform the healthcare system to improve patient care and contain cost for our customers.”

Cigna spokeswoman Amy Turkington said the company “believes in respecting the court’s process. We remain focused on our global customer programs, and are prepared to proceed as appropriate on behalf of our customers when the court deliberations reach their conclusion.”

According to the federal Department of Health and Human Services, more than 68,000 young New Jersey adults have gotten coverage under the ACA’s age-26 provision, which went into effect in late 2010. Nationwide, 2.5 million young Americans have taken advantage of it.

The health plans aren’t allowed to charge a separate premium for this extended coverage, which kicks in when a child ages out of the dependent provisions of the family health plan, typically at 21 or when he or she finishes college. Although the ACA does not allow health plans to charge an additional premium for the age-26 extension, the increased costs generated by additional claims get built into the premiums for health plans that cover children.

A 2005 New Jersey law requires health insurers to cover children up to age 31, but it’s not nearly as comprehensive as the federal law. New Jersey’s statute generally applies only to state-regulated insurance plans, whose members tend to be small- and mid-size employers, and does not apply to self-insured plans that are standard among large, private-sector employers.

Nevertheless, the law does apply to health plans that cover state employees and public school employees, even though both plans are self-insured. Those two public-employee health plans cover a total of 855,000 people. An adult child who takes advantage of New Jersey’s coverage-to-age-31 program is charged a separate premium, and the employer does not have to contribute. In New Jersey, 13,500 children are covered by the state program.
David Knowlton, president of the New Jersey Health Care Quality Institute, said of the Aetna and UnitedHealthcare decisions to extend some ACA reforms: “I’m pleased they are going to do that, and I’m not surprised. These are immensely popular actions, so I’m not at all surprised that that’s what they are going to do.”

This story has been updated from an earlier version.