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Source article Read more on Medical News Today

Kids to get coverage as part of state’s health care overhaul

for MediaNews Group

The Saratoga teen also may be among the first Californians helped by the new health care overhaul that will guarantee children access to insurance coverage.

Shortly after Miranda was born, doctors diagnosed her with biliary atresia, a blockage or absence of ducts that prevents bile from leaving the liver and leads to cirrhosis. Without a transplant, her liver would fail.

“They said, ‘Your daughter has a condition that’s incompatible with life,’” said her mother Michele Ashland, 47.

Miranda got a new liver when she was 6 months old and is now a thriving freshman at San Jose’s Lynbrook High School.

Only two things remind the Ashland family of Miranda’s long-ago health battle, her mom said — the daily pill to prevent her body from rejecting the transplanted liver and the ,000 monthly insurance bill.

That’s the premium for health coverage Kaiser Permanente charges for four of the five Ashlands, including Miranda.

“We are sinking,” Michele said. When she tried to buy a more affordable Kaiser plan in 2008, she was told two members of the family wouldn’t qualify because of pre-existing conditions: Miranda for her liver transplant and her father Tom, who had a heart attack that year.

“As a consumer I feel really powerless. They can decide anything they want and that’s it,” Michele said. “Until we Advertisementgo bankrupt, we have to keep paying these premiums in order to keep having insurance.”

Starting in September, families like the Ashlands may have another option.

That month, a provision of the new federal health law will prohibit insurance companies from denying coverage to children with pre-existing conditions, which can range from Miranda’s liver transplant to more common diseases such as asthma, autism and diabetes.

“We’ve also heard of children who were denied who had ear infections or acne, something that almost everybody gets,” said Kelly Hardy, health policy director for Children Now, a national children’s advocacy group based in Oakland.

Some 576,500 California children under 18 have pre-existing conditions regardless of their health insurance status, according to Families USA, a national health care consumer advocacy group.

It’s not clear how many such children lack health insurance, but Hardy and other experts say the number isn’t huge because most have coverage through their parents’ plans or public programs such as Healthy Families and Medi-Cal.

Nonetheless, they say, this change will protect uninsured children and their parents, who risk financial ruin to pay the medical bills.

“The idea that as a parent, you would be able to have health insurance but your child cannot is just so wrong,” said Beth Capell, lobbyist for Health Access, a statewide health care consumer advocacy group.

The population of children with pre-existing and chronic conditions has grown in part because of medical advances, said Lisa Chamberlain, a pediatrician at the Lucile Packard Children’s Hospital in Palo Alto and an assistant professor at the Stanford University medical school.

“As pediatric medicine has gotten better, kids are surviving more. But they are surviving with some consequences,” she said, such as monitoring and medication.

“From the perspective of an insurance company … they’re still going to be seen as a higher-risk person to insure,” she said.

After Congress passed the health care bill, some insurers argued that it did not require them to cover children with pre-existing conditions until 2014, when the major provisions take effect.

Health and Human Services Secretary Kathleen Sebelius quickly chastised them. She said that her department is drafting regulations to clarify the requirement, but this much is clear:

n As of Sept. 23, children with pre-existing conditions cannot be denied access to their parents’ health insurance plans.

n Insurance companies cannot insure a child while excluding treatments for his or her pre-existing condition.

The new rule applies to all employer plans and new plans in the individual insurance market, HHS says.

Health insurers pledged to cooperate. “We await and will fully comply with regulations” wrote Karen Ignagni, president and CEO of America’s Health Insurance Plans, which represents insurers.

Some advocates and parents fear insurers will agree to cover the children, but with unaffordable premiums.

A legislative initiative is aimed at the same concern. Assemblyman Mike Feuer, D-Los Angeles, has proposed limiting premiums for children with pre-existing conditions starting next year until 2014, when the federal rules take effect.

“The insurance companies will definitely argue that this will cost a lot of money,” said Bruce Lesley, president of First Focus, a national child advocacy group.

He doubts that’s really true. The population of children with pre-existing conditions is not large to begin with, he said, and public health programs have shown that insuring children with pre-existing conditions need not be costly.

The rule may actually save insurers, hospitals and others money, said Paul Knepprath, a vice president of the American Lung Association in California.

“We know that emergency room visits are very expensive for everybody,” he said. “Providing kids with asthma the opportunity to get treatment, get preventive care, will help save money for all.”

Emily Bazar is a senior writer at the California HealthCare Foundation Center for Health Reporting. The center is an independent news organization devoted to reporting about health care issues that concern Californians. It is headquartered at the USC Annenberg School for Communication & Journalism and is funded by the nonprofit, nonpartisan California HealthCare Foundation. Contact Bazar at ebazar@usc.edu or 916-442-6911, ext. 18.
Source article Read more on The Daily Democrat