When does guaranteed coverage for sick kids start?

With the ink barely dry on Congress' landmark health care legislation, insurers already are disputing whether they must cover children with pre-existing medical conditions starting this year.

The president says yes.

Insurance companies say no.

In recent speeches, President Obama has described the new protections in no uncertain terms. "Starting this year, insurance companies will be banned forever from denying coverage to children with pre-existing conditions," he said at a rally in Virginia on March 19.

But even as their lawyers pore over every comma, the nation's insurers deny the law says that.

America's Health Insurance Plans (AHIP), the industry trade group, agrees that in six months, insurers must cover pre-existing conditions for a child they choose to enroll. But they say the law doesn't require them to offer coverage to a child with pre-existing conditions -- not until 2014, when they will have to guarantee coverage to everybody.

"Our industry is moving forward with implementing all of the reforms in a manner that will minimize disruption for the more than 200 million Americans we serve," AHIP spokesman Robert Zirkelbach said in a statement Monday. "We understand policymakers are contemplating changes ... and we will implement any revisions that are made."

It's hard to estimate how many children would be affected in Minnesota, but the number probably is small. The debate applies only to those who buy their own health insurance in the individual market -- 5 percent of Minnesotans, though the number is growing. Those who are covered by an employer don't have to worry about being denied for pre-existing conditions.

In Minnesota, the three biggest health plans said they are still trying to figure out how to interpret the law. Blue Cross and Blue Shield of Minnesota, Medica and HealthPartners directed questions to the Minnesota Council of Health Plans.

"It sounds like the language that was signed into law doesn't reflect the intent of Congress or the president," said council Executive Director Julie Brunner.

Ultimately, Brunner said, Minnesota plans would follow the rules drafted by the U.S. Department of Health and Human Services in coming months.

PreferredOne, the state's fourth-biggest insurer, said whatever's ultimately decided will be followed by all the plans. Insurers in any one market tend to follow suit because nobody wants to be landed with all the sick people.

High-risk pools

Some of the affected children are now covered through the Minnesota Comprehensive Health Association (MCHA), a subsidized, high-risk pool for people whose pre-existing conditions preclude them from buying insurance in the individual market.

Of MCHA's 27,000 members, 2,258 are 19 or younger. Of those, 889 are policyholders, meaning they are the ones with pre-existing conditions.

What's hard to know is how many more are out there without insurance because they can't afford it, said MCHA President Lynn Gruber. MCHA's premiums are about 20 percent higher than the individual market.

Under the new law, most children with pre-existing conditions will likely be covered under their parents' health plans until age 26, said Merz of PreferredOne. He estimated that would cover 90 percent of kids who need it.

The day after the bill was passed, people were calling up health plans saying "I have a pre-existing condition. You can take me now," recalled Brunner. Meanwhile, employers are peppering their insurers with questions on which parts of the bill apply to them and which don't.

"This is the first of a number of interpretation issues we're going to be dealing with," Brunner said.