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Congress Urged To Include Youths in Health-Insurance Plan

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WASHINGTON--Any health-insurance-reform bill adopted by the Congress must include provisions that specifically target the health-care needs of children and adolescents, child-health advocates said last week.

The advocates, addressing a hearing conducted by the House Select Committee on Children, Youth, and Families, said that, to date, the health-care needs of children and adolescents have often been overlooked in the the national debate about the best ways to provide health coverage to the uninsured.

"The reform movement must pause long enough to hear the special needs of children, teenagers, and pregnant women,'' said Sarah S. Brown, the senior study director of the National Forum on the Future of Children and Families at the Institute of Medicine.

Like Ms. Brown, other child-health experts are hoping to capitalize on the newfound interest in health-care reform to close long-standing holes in federal and state child-health programs. (See Education Week, Feb. 5, 1992.)

Many of the reform proposals currently under scrutiny by the Congress, Ms. Brown and others at the hearing said, would do little to ensure that the estimated 12 million children and adolescents who lack health insurance, or about one-third of all uninsured Americans, and the millions of additional children who are underinsured would receive proper medical care.

Ms. Brown, drawing on her experience as the editor of a recent Institute of Medicine study that compared the child-health provisions of seven health-care proposals, said that some of the plans would encourage, although not require, health-care coverage for children.

Other plans, she said, while making provisions for all children, do not include some of the health benefits they most often need, such as prescription drugs and dental care.

"Simply putting an insurance card into the hands of people will not ensure the presence of providers,'' she said, noting that there are not enough pediatricians in the inner cities or in rural areas.

Also, she said, many moves to curtail health-care costs, such as excluding coverage for a known health condition for a certain period of time before it is included on a new health-insurance policy, are counterproductive.

"What is it going to be--early prenatal care or waiting periods?'' she asked. "The two are incompatible.''

'It Does Not Work'

At the hearing, several families told of their struggles to purchase health insurance for children with pre-existing conditions.

Kathleen Renshaw, a part-time teacher from Encinitas, Calif., said her family's health-insurance premium rose from about $3,500 a year to $16,000 within several years after her young daughter, Marisa Harvey, was operated on for a blocked kidney.

She said the only health-insurance coverage she can get for her child is a state-backed policy for kidney-related illnesses only. In order for Marisa to maintain the state coverage, however, Ms. Renshaw said, the family's income cannot exceed $40,000 a year.

As a result, she said, she and her husband are considering separating or divorcing to maintain the coverage.

"We would be more than willing to purchase insurance, if we could buy it,'' Ms. Renshaw said.

"Parents cannot negotiate the situation,'' said Dr. Richard P. Nelson, the president of the Association of Maternal and Child Health Programs. "It does not work.''

Others at the hearing noted that adolescents, even if the most comprehensive proposals are adopted, may still lack good medical care because of such barriers as parental notification and a shortage of adolescent-medicine specialists.

"Even if we have universal financial access to health care, adolescents will still face additional barriers,'' said Dr. Robert L. Johnson, the director of the division of adolescent medicine at the New Jersey Medical School in Trenton.

"I'm afraid we'll do something and later say, 'Oops!,' '' said Representative Patricia Schroeder, the Democrat from Colorado who chairs the select committee. "And if there is one area in which we may do this, it would be in adolescent medicine.''

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