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Lobbyist Money Help  

Legislature weighs merits of mandated health benefits

April 16, 2003
By: Melissa Maynard
State Capital Bureau

JEFFERSON CITY - When six-year-old Olivia Penn's wig fell off in dance class last week, her fellow ballerinas laughed and stared at her bare head. What they don't understand, explained Olivia's mom Jody Penn, is that Olivia is sick.

Olivia suffers from alopecia, an autoimmune skin disease that causes hair loss. By the time Olivia was one, she didn't have a hair left on her body.

And the insurance companies don't understand much better than the ballerinas do, Jody Penn said. They've refused to help pay for Olivia's hair prostheses, which cost $1600 to $4500 each and need to be replaced every three months.

Jody Penn testified last month in support of a bill that would require insurance companies to pay for the wigs of people who suffer from alopecia.

"It's real important that we take care of our kids in Missouri, because obviously the insurance companies don't want to," Jody Penn said.

But opponents of this bill and the dozen or so others before the legislature that would place requirements on insurance companies say that for every Olivia, there's a person who may be forced to do without any health insurance because of increases in premium prices caused by the additional mandates.

The Legislature is considering bills that would require health insurers to cover everything from chiropractic care to weight reduction services to clinical trials for cancer patients to mental health care.

"Every time you add a mandate for a particular interest group it means that the cost of insurance is going to rise for everyone who pays insurance premiums," said Calvin Call, lobbyist for the Missouri Insurance Coalition. "And although the there are a lot of special needs out there, if you have a small segement of society with high risk illnesses, should the rest of society, socialistically, have to pay for their illnesses?"

Call said that individuals should shop around and meet with insurance representatives annually to ensure that they have a policy that fits their particular needs.

But Sen. Pat Dougherty, D-St. Louis City, who has sponsored and is sponsoring legislation that requires insurers to pay for cancer tests, treatments, and trials, noted that because of the unpredictable nature of illnesses, people aren't always able to predict which policies will fit their needs.

"The purpose of a mandate is to provide health care coverage, and it's usually to provide health care coverage to someone who doesn't have a symptom," Dougherty said.

In the case of cancer patients in particular, Dougherty said that national data has proven that covering tests and treatments often saves insurance companies money in the long run, as later treatments are more costly.

"It saves lives -- which is what I really thought health insurance is all about -- and in the long run it saves money," he said.

Rep. Bryan Pratt, who serves on the House Health Care Committee that has passed a number of these mandates, said that while he voted in favor of some of the mandates, he fears the Legislature may be in danger of carrying good intentions too far.

"What scares me is that we may be on the path to saying every single health condition is covered, whether it be something experimental, whether a chiropractor is doing it, whether a witch doctor is doing it, it's going to be covered," he said. "Then, only the rich will be able to afford health insurance."

The Senate is in the proccess of debating a bill that would create a Mandated Health Benefit Review Commission to review all existing and proposed and future requirements on health insurers. This commission would be required to study the projected financial and societal impact of the statutes and make recommendations to the Legislature. Similar commissions have been created in three other states. The bill would also repeal a number of requirements on health insurers that deal with hospitalization plans.

The bill's sponsor, John Loudon, R-St. Louis County, said that for every one dollar insurance premiums rise, approximately 100,000 people are dropped from their health care plans because they are too expensive. He said that consumers should be able to have the option of choosing which plan is right for them.

"We've basically said that everyone needs to be driving a Cadillac," he said. "And if all you can afford is a Hugo, then we're not going to let you have a car."