Aetna, Anthem Blue Cross, Cigna, Humana, WellPoint, and the Golden Rule subsidiary of UnitedHealth are among the companies that have decided to stop selling child-only policies rather than comply with the new Patient Protection and Affordable Care Act (PPACA) requirement that they cover children with pre-existing conditions effective September 23, 2010. The U.S. Department of Health and Human Services and others have criticized their decision, which will likely make children's coverage more expensive and difficult to find. The PPACA doesn't require insurers to sell new child-only policies, and children will still be able to obtain coverage on their parents' plans.

Some of the insurers cite uncertainty as to how the rules to be promulgated under the PPACA will be implemented, and the potential impacts of these rules on them, as a basis for their decisions.