Mar. 23--While most provisions of the health care overhaul package are not slated to take effect for years, families of children with chronic or severe illnesses can expect almost immediate relief from health insurance companies.
Under the legislation, insurers will be required to provide health coverage for these children, even those with pre-existing conditions such as Down syndrome or childhood diabetes, who might otherwise be disqualified.
"Any time there is more mandated coverage, it will increase the cost of coverage, but we don't know what the full impact will be," said Robert Zirkelbach, press secretary for the American Association of Health Plans-Health Insurance Association, a trade group based in Washington.
Also this year, the bill will allow young adults to remain on their parents' insurance policies until they are 26 years old, if they do not have jobs that provide health coverage.
Overhaul advocates have praised the bill's immediate effect on children.
"Anything that we do to get the kids access to health care, we're thrilled about," said Julie Leicht, senior policy director of Citizens for Missouri's Children, referring to the 130,000 children in the state who lack health insurance.
But health experts said the proposed regulations pertaining to children will result in higher premiums for consumers. The issue of who will pay the medical costs of the nation's uninsured and underinsured children, especially those with potentially debilitating and lifelong conditions, is not yet settled.
Health care costs can be tremendous for parents whose child requires significant treatment by specialists or long-term care. Health insurers' operating costs under the bill are likely to balloon, at least in the short term, experts said. And it is unclear to what extent the federal government may subsidize those costs.
Local advocates of the health care overhaul called the House vote just the first step in a long process, especially in states like Missouri, where pending legislation aims to derail it.
Those efforts could block portions of the federal bill from becoming the law in Missouri, particularly a mandate for most residents to buy health insurance or face fines.
That mandate would extend coverage to more people, increasing the size of the insurance risk pool, helping to cover the cost of the chronically ill.
Ruth Ehresman, director of health and budgetary policy for the Missouri Budget Project, said affordable insurance pools only work if young and healthy people join in along with those who have pre-existing medical conditions. She said that effort could be undermined by Missouri legislative opponents.
"Constitutionally we don't believe that states can opt out of this federal law," she said. "For states like Missouri to get involved in these very expensive legal battles just doesn't make sense."
Other groups said they look forward to pushing the state to nullify parts of the bill.
"States like Missouri have the opportunity under the Senate bill to opt out of the abortion coverage provisions of the bill, and that's what our organization and others will now be focused on," said Joe Ortwerth, executive director of the Missouri Family Policy Council.
The president of the Missouri Foundation for Health said he hopes people with and without insurance can come to understand the benefits of the legislation.
Experts say it's difficult to estimate how many children the overhaul will affect and how many families would sign up for coverage.
"It's a noble thing, trying to get uninsured people insured. The question is, how do you do it?" said Vincent Blair, a veteran broker of health insurance policies whose office is in Webster Groves. "If they make the children insurable today, I would think that would have some pressure on the prices."
Health care experts agree the potential costs of insuring chronically ill children are uncertain.
"Everyone wants to know what's going to happen and when it's going to happen," said Steve Lipstein, CEO of BJC HealthCare, the largest provider of health care for the uninsured in Missouri. The company runs Barnes-Jewish Hospital in St. Louis as well as other hospitals.
"The one thing we don't know is how many people the private insurance companies will have to insure by virtue of pre-existing condition," he said.
Tim McBride, a health economist and associate dean of public health at the Brown School at Washington University, said he expects the cost of mandating health coverage for chronically and severely ill children to be "absorbed by the health insurance companies, causing them to raise premiums."
By 2014, when millions of Americans are required by law to be insured, he said, the risk pool should expand to more easily cover those with pre-existing conditions.
"A lot of people said, 'Let's ban pre-existing conditions.' That all sounds good. It helps people who need help immediately. But you have to make sure that they're covered through (insurance risk) pools," McBride said. "There's a relatively small number of really sick kids with pre-existing conditions, but the costs are high."
But, he added, providing health insurance to young adults on their parents' health plans will enhance the nation's insurance pool because it is a relatively healthy group, which could help offset the cost of younger children with severe illnesses.
In addition, a tax credit to encourage small businesses to enroll their employees in health plans also will expand the risk pool to help pay for the chronically ill.
Insurance company representatives were circumspect about the legislation.
"It's still a bit premature to speculate on the specifics of the legislation and its implementation," said Daryl Richard, a spokesman for United Healthcare, one of the region's largest insurers.
Kim Ashley, a spokeswoman for Anthem Blue Cross and Blue Shield, applauded the provisions affecting children but said in a written statement, "We remain concerned the bill ... does not address long-term cost containment measures that will make the system sustainable."
Nearly a half-million uninsured Missourians and 1.1 million in Illinois could gain coverage under all provisions of the health care bill, including those that take effect in later years, according to data compiled by Families USA, a health care advocacy group based in Washington.
"Status quo health care is just not a viable option," said Ehresman, of the Missouri Budget Project. "People are losing their insurance, employers are dropping insurance, and increasing numbers of people find themselves with no affordable options."
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