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Senate Approves Health-Care Bill; Access Still Worries Advocates

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Washington

Under a health-insurance-reform bill passed last week by the Senate, millions of American families could more easily get and keep insurance coverage. But millions of uninsured Americans, including children, would still not have access to the health coverage they need, education and child advocates said.

"This is a modest but helpful step for families and children," said Stan Dorn, the director of the health division of the Children's Defense Fund, a liberal advocacy organization based here.

The fate of the insurance-reform bill sponsored by Sen. Nancy Landon Kassebaum, R-Kan., and Sen. Edward M. Kennedy, D-Mass., is still uncertain. The Senate's 100-0 vote in favor of the measure belied the contentious nature of the floor debate and the difficulties facing conferees who must work out significant differences between the Senate plan and a health-insurance bill passed earlier in April by the House.

Both bills would make it easier for people with health insurance to keep that coverage if they changed jobs or health plans. Under the bills, health insurers could not limit or deny coverage to someone with a pre-existing medical condition for longer than a one-time, 12-month period. Once that period expired, no new exclusions for pre-existing conditions could be imposed on those who maintained their coverage, even if the insured person changed or lost a job.

The bills would also prevent an employer's health plan from excluding any employee from coverage based on health status.

Big Differences

But the bills' disparities are considerable. Most notably, the House version would allow taxpayers to make tax-deductible contributions to a medical savings account, similar to an individual retirement account, if they were covered by health insurance. The money could be withdrawn, free of taxes and penalties, for medical purposes.

The provision is controversial, and Senate sponsors fought hard to keep it out of their legislation to maintain bipartisan support. The White House has said that President Clinton would veto a bill containing medical savings accounts.

Proponents say such accounts would cut costs by giving individuals control over their health-care spending. Critics say they would lead healthy people to buy low-cost insurance with high deductibles, leaving only sicker people in traditional plans and thus increasing the cost of those plans.

The House bill also contains controversial limits on damages in malpractice cases.

The General Accounting Office, the investigative arm of Congress, has estimated that passage of the Senate bill would help at least 25 million Americans a year get or maintain insurance coverage.

"Among them are certainly millions of children with serious illnesses," Mr. Dorn said.

Whether a child had asthma or cancer, many families would no longer have to worry about losing coverage if the parents changed or lost jobs, said Marjorie Tharp, a Washington spokeswoman for the American Academy of Pediatrics, which supports the Senate bill.

Removing exclusions for pre-existing conditions would be helpful for children with major physical or mental disabilities, many of which are longstanding conditions, said Bruce Hunter, a senior associate executive director at the American Association of School Administrators in Arlington, Va.

School Costs

Currently, school districts are responsible for providing medical-related services at school for special-education students who need them, Mr. Hunter pointed out. To have health-insurance companies sharing some of that cost "would be an enormous assistance," he said.

Child and education advocates acknowledged that the pending bills fall short of the Clinton administration's promise of sweeping health-care reform, which died in the Democratic-controlled 103rd Congress. (See Education Week, Nov. 3, 1993, and Sept. 14, 1994.)

But they are glad to see progress.

"I can't see [this Congress] doing any more," said Patricia Collins Murdock, a lobbyist for the National Education Association. "They don't want to, and I don't think they have the time."

The ideal--but probably unrealistic--next step for Congress, several experts said, would be to help children with no health insurance.

"Not having health care causes all kinds of day-to-day learning problems for kids," Mr. Hunter said. "Kids are sitting there nursing an earache instead of paying attention."

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