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Tess Vigeland: One of the elements of health care reform that's already underway is the requirement that insurance companies cover kids with preexisting conditions. California created an open enrollment period for parents to buy those policies.
But the state is struggling to get them to sign up.
Marketplace's Jennifer Collins went to find out why.
Jennifer Collins: Nearly five million children in this country have preexisting conditions that can make health coverage too expensive -- or impossible to get.
One of those kids is Leila Wilkerson. She lives in southern California.
Leila Wilkerson: Dad!
Leila's father: Hold my hand, you're in the parking lot.
Leila: Daddy, jump up!
Leila's four years old, she's got long brunette ringlets and she loves her gymnastics class, especially...
Leila: Going inside squishy blocks. But there's a giant inside them.
Maggie Wilkerson: Who told you that?
That's Leila's mom Maggie Wilkerson. Leila's healthy. There's just one thing...
Maggie: I remember when she was five months old, she was laying on my chest and she had her head to the side and I kinda noticed a bulge on the back of her neck.
So she took her daughter to a pediatrician.
Maggie: And they discovered it was something called a hemangioma.
A hemangioma is a non-cancerous growth. It can be dangerous, but doctors said Leila's wasn't.
Maggie: So it was just simply a cosmetic thing.
At the time, the family had insurance. But Wilkerson's husband had been laid off. So when the insurance ran out, Wilkerson and her husband decided to remain uninsured and buy an individual policy for their daughter. But hemangioma was on a list of preexisting conditions.
Maggie: I can't tell you how many people I spoke with and I assured them, I said, "This is not something that interferes with her physically." But it was on the list. No insurance. That's it.
Under health care reform, insurance companies can't turn away children because of preexisting conditions. But premiums can be high. To boost the number of insured kids, California created special enrollment periods, when premiums are capped for sick kids and often discounted for healthy ones. The idea is to attract enough healthy kids to cover the cost of the sick.
Patrick Johnston is president of an insurance trade association in California.
Patrick Johnson: The system can be gamed if people jump in and out at will. So it is better for everyone if people buy annually and have open enrollment periods.
In California -- which could become a model for other states -- the enrollment period has been open for over a month. But many people have yet to sign up. State budgets are so tight, officials can't completely afford to get the word out.
Kelly Hardy: Unfortunately, there's some state outreach programs that were cut.
Kelly Hardy is with the advocacy group Children Now.
Hardy: So parents may not know just because they may not have ever heard of the open enrollment periods.
Maggie Wilkerson didn't know about it, but she says even if she had, the price is still too high.
Maggie: I can't do. I will not do it. I'll deal with paying for her cash when she needs to be seen. but I'm not going to give an insurance company $600 or $700 monthly.
One year, Leila's check-ups and a visit or two to the emergency room cost the family more than $6,000. Wilkerson was eventually able to get her daughter insured through a non-profit plan, but at that time, she and her husband had little income. Now, they're self-employed, although still uninsured. And they may soon earn too much to qualify for Leila's policy. That would force them to choose -- once again -- between the certainty of high premiums and the risk of paying cash.
I'm Jennifer Collins for Marketplace Money.