Schwarzenegger grapples with new medical insurance laws
As he considers 10 bills passed by the Legislature that would expand what insurers must pay for, he must balance improved coverage with the risk of driving costs so high that people can't afford it.
SACRAMENTO — Garrett Warren, 14, needs braces to fix the gaps in his teeth caused by a severe cleft lip and palate that have already required seven operations. But his family's insurance plan won't pay for them, though Warren's doctors say the braces are necessary before they can begin a final round of surgeries.
"It's so important for his whole treatment," said his mother, Becky. "Just because you hear the word braces or teeth doesn't mean it's dental."
As insurers try to limit their payouts and new treatments become available, patients are finding more gaps in what their medical policies will cover. As he considers 10 bills passed by the Legislature that would expand what insurers are required to pay for, Gov. Arnold Schwarzenegger must balance improved medical coverage -- for those who have it -- with the risk of driving costs so high that people can't afford it.
The new health coverage requirements include maternity services; tests for the HPV virus, which can cause cervical cancer; and treatment for most mental health and substance abuse problems. The broadest would enhance existing medical coverage for 18 million Californians. The narrowest would help a few hundred patients.
For example, about 300 people a year would benefit from the proposal that insurers cover orthodontia needed for cleft palate patients, increasing monthly premiums by a third of a cent.
But together, the new mandates would increase premiums by $383 million a year, or 0.5% of the $74 billion employers and individuals now pay to insurers each year, according to the California Health Benefits Review Program, a University of California office that analyzes such proposals for the Legislature. The premium increases affecting maternity and mental health mandates alone would prompt 3,200 people to drop their coverage, UC experts estimate.
Other proposals would require insurers to pay for screening for HIV in people without symptoms and for the cost of special formulas and foods for people whose digestive tracts can't absorb nutrients because of a rare genetic disorder. Two bills would compel insurers to offer the option of purchasing extra coverage for hearing aids for children and durable medical equipment such as wheelchairs.
Another bill would bar insurers from refusing to pay for the treatment of people who sustained injuries because they were impaired by drugs or alcohol. And one measure, to cover acupuncture, was vetoed by the governor last month.
