AAP Headquarters 

141 Northwest Point Blvd 

Elk Grove Village, IL 60007-1098 

Phone: 847/434-4000 

Fax: 847/434-8000 

E-mail: kidsdocs@aap.org 

www.aap.org 

Reply to 

Department of Federal Affairs 

Homer Building, Suite 400 N 

601 13th St NW 

Washington, DC 20005 

Phone: 202/347-8600 

Fax: 202/393-6137 

E-mail: kids1st@aap.org 

Executive Committee 

President 

O. Marion Burton, MD, FAAP 

President-Elect 

Robert Block, MD, FAAP 

Immediate Past President 

Judith S. Palfrey, MD, FAAP 

Executive Director/CEO 

Errol R. Alden, MD, FAAP 

Board of Directors 

District I 

Edward N. Bailey, MD, FAAP 

Salem, MA 

District II 

Henry A. Schaeffer, MD, FAAP 

Brooklyn, NY 

District III 

Sandra Gibson Hassink, MD, FAAP 

Wilmington, DE 

District IV 

Francis E. Rushton, Jr, MD, FAAP 

Beaufort, SC 

District V 

Marilyn J. Bull MD, FAAP 

Indianapolis, IN 

District VI 

Michael V. Severson, MD, FAAP 

Brainerd, MN 

District VII 

Kenneth E. Matthews, MD, FAAP 

College Station, TX 

District VIII 

Mary P. Brown, MD, FAAP 

Bend, OR 

District IX 

Myles B. Abbott, MD, FAAP 

Berkeley, CA 

District X 

John S. Curran, MD, FAAP 

Tampa, FL 

December 17, 2010 

Lisa Campbell 

Department of Health and Human Services 

Office of Consumer Information and Insurance Oversight 

Room 445–G 

Hubert H. Humphrey Building 

200 Independence Avenue, SW 

Washington, DC 20201 

Attention: OCIIO-9991-IFC2 

Dear Ms. Campbell: 

The American Academy of Pediatrics (AAP), a non-profit professional organization of 

60,000 primary care pediatricians, pediatric medical sub-specialists, and pediatric surgical 

specialists dedicated to the health, safety, and well-being of infants, children, adolescents, 

and young adults, appreciates this opportunity to submit comments regarding the 

Amendment to the Interim Final Rules for Group Health Plans and Health Insurance 

Coverage relating to Status as a Grandfathered Health Plan under the Affordable Care Act. 

In general, the Academy reognizes that children need services that are not necessarily 

guaranteed by grandfathered plans. As such, the Academy would urge the Departments of 

Health and Human Services, Labor and Treasury to promulgate regulations which promote 

access by children to plans that do not retain grandfather status. 

Thank you very much for your attention to the views of the American Academy of 

Pediatrics. 

Sincerely, 

O. Marion Burton, MD, FAAP 

President 

OMB:rh 
Amendment to the Interim Final Rules for Group Health Plans and Health Insurance 

Coverage Relating to Status as a Grandfathered Health Plan Under the Patient Protection 

and Affordable Care Act (26 CFR Part 54, 29 CFR Part 2590, 45 CFR Part 147): 

The American Academy of Pediatrics (the Academy) is dedicated to the health of all children. 

The Academy’s Access Principles call for all children to have access to quality health insurance 

as well as all recommended and needed services. The Affordable Care Act lays the groundwork 

to achieve this goal, with its focus on preventive services and essential benefits in Exchange 

plans. Nevertheless, the Amendment to the Interim Final Rules for Group Health Plans and 

Health Insurance Coverage Relating to Status as a Grandfathered Health Plan (the Amendment) 

makes it easier for employers to exclude children from accessing the services they need from 

appropriate clinicians. 

Overall, the Academy congratulates the Departments of Treasury, Labor and Health and Human 

Services (the Departments) on crafting a rule designed to strike a balance between continuity of 

coverage and consumer protections. Nevertheless, the Academy would prefer narrower criteria 

for plans to retain grandfather status. This is because a loss of grandfather status leads to 

positive results for insured children. In particular, access to no copay-preventative services is 

incredibly important for the pediatric population, but grandfathered plans are not required to pay 

for access to these important benefits. 

The importance of prevention. The Grandfather Regulation creates a regime in which families 

may find it harder to access the preventive services that their children need in grandfathered 

plans. While cost is an important issue for health insurance, adding no copay preventive services 

and other consumer protections should not raise cost precipitously for plans, and will certainly 

save costs for society as a whole. In particular, preventive services like immunizations and well 

child visits have a strong return on investment and making them more readily accessible is 

clearly within the spirit of the Affordable Care Act. With these arguments in mind, the Academy 

believes that the new consumer protections from the Affordable Care Act should apply to as 

many plans as possible, and therefore, would urge that the retention of so-called grandfather 

status be a much more difficult proposition than is set forth in the Grandfather Regulation. All 

children need preventive services, and discouraging families from using them (the rationale for 

cost sharing) for years can be devastating to children. This policy also leads to unnecessary cost 

for the system because the focus of pediatric prevention is to detect and address health problems 

early. Early prevention and care in childhood leads to healthier adults with accompanying lower 

health care costs. 

Because of the quality and importance of the Bright Futures program, in fact, we would urge the 

Departments to roll back the Amendment so that no-copay access to Bright Futures services is 

mandatory for all public and private insurance coverage in the United States.