What a Coincidence

An opportunity to improve preventive health care for children in California has been created by the fortunate coincidence of a wise decision by the U.S. Supreme Court and the adoption of a new measure by the California Legislature.

The court, in an 8-0 vote, has affirmed the authority of states to mandate specific health-care benefits in insurance written in individual states. The authority had been challenged by some insurance companies’ assertion that federal regulations had primacy.

Twenty-six states have mandated a total of 69 benefits for health insurance, according to the Health Insurance Assn. of America. These include provisions for the care of particular illnesses, such as mental disorders and alcoholism, and the services of particular providers, such as dentists. Insurers in California must offer a variety of coverages to employers contracting for health insurance for employees. Cost-conscious companies have been reluctant to exercise the option for preventive child-health programs, however.

On the day of the court decision the Legislature completed the enactment of AB 424, sponsored by Assemblyman Louis J. Papan (D-Millbrae). It would require comprehensive preventive health care for children up to age 16 as part of all health insurance in the state. This would be based on the standards for physical examinations, immunizations, laboratory tests and other services adopted by the American Academy of Pediatrics. These protections already are provided children under Medi-Cal and in private health-maintenance organizations.

The State Chamber of Commerce and the Assn. of California Life Insurance Companies have led the opposition, concerned about the initial cost and the extension of mandatory action. They also point out that the decision apparently still leaves exempt from these state requirements the growing number of employers who opt for so-called self-insured health programs, as opposed to health-insurance policies.

Those are not good reasons for passing up this opportunity to extend coverage. The reluctance of employers is at best shortsighted, for almost everyone agrees that in the long term this program would be cost-effective.

The legislation now goes to Gov. George Deukmejian for signature, with the endorsement of dozens of groups working with young people. Their advocacy is motivated by first-hand experience with the existing system that denies so many children the chance for better health that is inherent in the early detection of problems and protection from disease.