A question of what to cover

From: Newark Star Ledger, NJ - Apr 27, 200

Health insurance mandates raising concern in Jersey

Sunday, April 27, 2003

BY TOM HESTER
Star-Ledger Staff

Each weekday, Jeanine Gleba drives her young daughter Grace from their home in Washington, Warren County, to a speech school in New Providence, 40 miles away.

There, the hearing-impaired child practices her speech, plays with children like herself and prepares for kindergarten.

At 3 years old, Grace is due for new hearing aids. They won't come cheaply: The hearing aids Grace has now cost $4,000, and Gleba expects a replacement set will be at least that much. But her family's insurance plan will not pick up the tab.

So for the past year, Gleba has pressed lawmakers to mandate medical coverage for the cost of hearing aids for children 18 years old and younger. The sponsor of the bill, Assemblyman Neil M. Cohen (D-Union), has named the proposed legislation Grace's Law.

Gleba's activism has placed her at the center of a growing controversy over whether the state should be dictating what insurance companies cover.

In recent years, lawmakers have enacted a steady stream of legislation ordering insurers to cover a wide range of medical procedures. More than two dozen bills, including Grace's Law, are pending in Trenton. Now, the leaders of the state Senate say lawmakers should slam the brakes on mandating health coverage until they figure out the cost.

"Each and every bill individually seems like a very good idea," said Senate Co-President John Bennett (R-Monmouth). "The problem is that collectively they substantially add to the cost of health insurance."

Bennett and Senate Co-President Richard Codey (D-Essex) have introduced a bill to create a 13-member commission to review measures that force insurers to provide specific coverage. The panel, which would include at least six members from the health insurance industry, would examine the medical and social impact as well as cost to insurers, employers and government health plans.

When he was in the Assembly in the early 1990s, Gov. James E. McGreevey was the prime sponsor of legislation that forces insurance companies to cover the cost of mammograms. McGreevey spokesman Micah Rasmussen said, however, that now may be the time to look at the mandated health coverage issue, noting that it affects the cost of running state and local government.

"I think we would be supportive of taking look at the impact of mandates on cost of coverage," Rasmussen said. "We know the cost of coverage has an impact on property taxes, state taxes and the cost to employers as well."

Bennett said each time health coverage is mandated, there is a risk of raising insurance costs and of forcing small employers or individuals to drop coverage. He said New Jersey "probably has one of the most generous mandated health coverage packages of any state."

Over the past few years, new laws have mandated full or partial insurance coverage for in vitro fertilization, Pap smears, formula for infants with a milk intolerance and hearing-loss screenings for newborns.

Pending bills call for full or partial coverage of hairpieces for people receiving chemotherapy, counseling for compulsive gambling, ovarian cancer screenings, Lyme disease and hepatitis B vaccinations, the AIDS vaccine, and for treatment for post-traumatic stress, drug and alcohol addiction, joint disorders, autism and cystic fibrosis.

THE CONSUMER FACTOR

Bridget Devane, who oversees health care issues for New Jersey Citizen Action, a consumer advocacy group, said the state needs to mandate health coverage to protect consumers. She said mandated coverage generally involves health issues for women and children.

"We tend to generally support mandating health benefits because of the many concerns faced during the last few years about managed care," Devane said. "We do need to guarantee that people have easy access when they need care."

Such guarantees, however, carry a price tag, according to the NJ HMO Association, the lobbying arm for eight major health insurance companies that provide 97 percent of the coverage in the state.

Michele K. Guhl, NJ HMO president and a former state Human Services commissioner, said 15 percent of annual health insurance increases can be traced to new mandates. She said the state's decision to mandate coverage for in vitro fertilization last year raised premiums at least 3.5 percent. A recent survey by the New Jersey Business & Industry Association found health benefits costs increased 15 percent in 2002, the steepest one-year increase in at least a decade.

"Every one of these mandates appeals to some people; they have emotional roots to them. It is pretty darn personal and emotional," said Guhl. "When the government keeps mandating benefits, it keeps increasing the cost of health insurance, and people at the end of the food chain become uninsured."

Advocates for mandates say they are merely prodding insurers who should have covered these procedures in the first place.

One of the more controversial proposals would require coverage for mental health care for children as well as treating post-traumatic stress, anxiety disorders, and drug and alcohol problems for adults.

THE ADDED COST
Health insurance providers have told lawmakers they fear such coverage could raise insurance premiums 5 percent to 10 percent. The Mental Health Association of New Jersey maintains it would be a 3 percent increase at most.

Marie Verna, the Mental Health Association's consumer advocacy director, argues the estimates do not consider the benefits of covering mental illness care.

"There is a hidden gain," Verna said. "People remain in the work force, paying into their health insurance, staying employed and paying taxes. If children go untreated, it can lead to drugs, alcohol and the criminal justice system. All of that because they are not ready to say kids need mental health treatment. I consider it a form of discrimination."

Assemblywoman Arline M. Friscia (D-Middlesex) is sponsoring legislation that would require coverage for the cost of wigs for people who lose their hair after chemotherapy or as a result of an accident. Saying a decent wig can cost $1,000, Friscia maintains this is not a frill.

"I have had several friends go through chemotherapy and it is difficult getting coverage for wigs," Friscia said. "Insurance companies resist paying for it, although it is an important part of the recovery after going through a difficult experience."

Gleba said there should be no question about covering hearing aids for children.

"It is ludicrous that insurance companies would deny a child the opportunity to learn to hear, speak and communicate," Gleba said. "Treatment of hearing loss with hearing aids is not a lifestyle adjunct or a luxury procedure like cosmetic surgery but rather a medical necessity."

About 700,000 New Jerseyans have some form of hearing loss, according to Ira Hock, executive assistant to the state Division of Deaf and Hard of Hearing. The cost of a pair of hearings aids ranges from $1,000 to $6,000, and growing children need a new set every three to five years.

The bill Gleba is pushing is stalled in committee. Democrats are proposing a less expensive alternative that would provide $2,000 per hearing aid set every 24 months for children 12 years old or under. Assemblyman Donald Tucker (D-Essex), the bill's co-sponsor, said 5 percent to 10 percent of New Jersey public school children have varying degrees of hearing problems. He noted many plans pay for hearing tests but not hearing aids.

Gleba has a mixed reaction to the new bill: "It is not terrific coverage," she said, "but something is better than nothing."

Children with profound hearing loss may undergo an operation to receive a hearing device implant, a procedure covered by health insurance. But Gleba said her daughter Grace has "moderately severe hearing loss" and must stay with a hearing aid.

"Life is hard enough without a disability," Gleba said. "Mandatory coverage will give these kids the fighting chance they deserve."

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