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High-risk insurance pool bridges gaps for babies

Gap in child-only health insurance market causing colic
BY PAULA BURKES pburkes@opubco.com Published: January 15, 2012
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When two health insurance companies denied coverage to her chronically asthmatic daughter Jaiden, Martha Wilson of Moore was starting to get frantic. Neither she nor her husband has employer-sponsored insurance. The doctor's office where Martha works as a receptionist doesn't offer it, and her husband is a self-employed used car dealer.

Meanwhile, Jaiden, 10, needs steroids to control her life-threatening asthma and Martha, a 31-year-old diabetic, requires daily insulin.

Thankfully, both now have insurance through Oklahoma's temporary high-risk pool, which the federal government funded in 2010 here and in other states for sick Americans as a bridge until 2014 — when affordable insurance must be made available to all.

Martha Wilson is grateful to pay a little more than $300 in monthly premiums for her and her daughter's health insurance. But she and her husband plan to expand their family soon, which leaves her worried about health insurance for that future, hopefully healthy child.

Health insurance for Wilson's hoped-for child, and infants and other future children in general, are the topic of a debate raging between state officials and child advocates.

With the passage of health care reform, the federal government mandated 18 months ago that insurers cannot deny coverage to children under 19 because of pre-existing conditions. Afraid of the financial risk, especially with critically ill newborns, most insurers nationwide — and all in Oklahoma — responded by immediately refusing to write any new child-only insurance policies.

But after Gov. Mary Fallin early last month signed an emergency change to Oklahoma's insurance laws allowing insurers to decide at what age they can begin coverage, Blue Cross/Blue Shield and CommunityCare, the state's two largest insurance carriers, agreed to return to the market for child-only policies for children 1 through 18. Open enrollment is under way through February.

“Since we've been covering Oklahomans for more than 70 years, we felt a responsibility to ensure that children have access to health coverage options,” BC/BS spokeswoman Hiliarie Houghton said in a statement to The Oklahoman last week. The company has a number of family policies that cover maternity and allow families to add newborns, regardless of health status, to policies within 30 days of birth, Houghton said.

“The child-only segment is too small of a segment to sustain the costs associated with covering infants,” Houghton said. “If insurers provided child-only policies at birth, catastrophic claims associated with neonatal care would overwhelm the balance between premium and risk.

This would likely force the rates on the entire child-only segment to be unreasonably high for all customers with child-only policies.”

Health care for uninsured babies 1 year old and younger won't go unmet, say officials, who argue that those children will be served in one or a combination of three ways:

• SoonerCare, the state/federal Medicaid program which, regardless of parents' income, provides free coverage to infants born to mothers covered under the program up to one year and all uninsured babies born less than 2 pounds, 10 ounces, until one month after discharge.

• The temporary, federally funded high risk pool.

• A state high risk pool, whose board is meeting later this month about stepping up to cover all babies, regardless of health, in that birth to 1 age group.

Still, some state lawmakers and advocates are yelling foul and calling for solutions legislated in other states that include covering all children under 19.

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At a glance

States' policies differ

Child-only policies are needed for a small percentage of children who are without private coverage for the entire family and who don't qualify for government-subsidized insurance, including children being raised by grandparents on Medicare. An estimated 4 percent, or 34,000, of Oklahoma children were covered by child-only policies in 2008-2009, the latest data available. Until recently, about 500 to 700 new policies were being written every year in Oklahoma.

Currently, 17 states do not offer child-only coverage. In Alabama, child-only products are available for children age 2 and up. Illinois and Texas sell child-only policies for children age 1 and up. In states like Kentucky and Maryland, child-only products are available only during a limited open enrollment, which occurs during one month each year.

SOURCES: The Oklahoma Insurance Department and Blue Cross/Blue Shield of Oklahoma

Information

To inquire about the Oklahoma High Risk Pool or the Oklahoma Temporary High Risk Pool, call toll-free (877) 885-3717.For questions about SoonerCare call (800) 987-7767

Did you know?

Oklahoma's “SoonerCare” state/federal Medicaid program for low-income families provides free health care to 471,797 children younger than 19, including 37,839 ages 1 and younger. In 2010, SoonerCare paid for about 64 percent of the births in Oklahoma. When a woman on Medicaid gives birth, her baby automatically is given a year of eligibility.

SOURCE: SoonerCare

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