Reform Plans Do Not Go Far Enough, Health Experts Say

Most of the health care reforms that have been proposed in Sacramento would do little to resolve the plight of growing numbers of children in California who lack medical insurance, health experts say.

The most prominent proposal, which the California Medical Assn. and others are trying to place on the November ballot, would force all businesses to provide an affordable--or bare-bones--health insurance policy for employees working at least 17 hours a week and their dependents.

But officials at Children Now, a statewide nonprofit advocacy group, say the plan fails to cover essential children’s services such as eyeglasses, hearing aids and dental care. In addition, the plan’s premiums, co-payments and deductible requirements are too high for large numbers of working poor families. And hundreds of thousands of children whose parents are jobless would not benefit from the plan.

The measure has yet to qualify for the ballot and is opposed by many insurance companies, small businesses, consumer groups and political officials, including Gov. Pete Wilson.

The governor favors a series of milder legislative measures that would put new controls on the insurance industry to hold down costs, thereby encouraging small businesses to purchase policies for their employees and dependents. State health officials acknowledged that the plan is not tailored to children and said they do not know how many uninsured youngsters would be helped by it.

There is growing support across the nation for changes that will allow insurance companies to offer low-cost health insurance that in some cases will provide even fewer benefits for children than are usually offered. To stimulate the growth of these plans, more than 20 states have enacted legislation waiving requirements that insurance policies provide certain minimum benefits.

This has freed insurance companies to offer bare-bones plans that in some cases do not cover adopted children, newborn care or treatment of childhood disorders such as cleft palates, experts say.

The only legislation that guarantees affordable, comprehensive care for children and pregnant women, according to Children Now, is the California Family Health Plan Act, which has a $1-billion price tag. The bill passed the Assembly last year and is pending before the Senate. Similar legislation has been introduced in Congress by Rep. Robert T. Matsui (D-Sacramento).

But the fiscal climate in Washington and Sacramento makes prospects of passage unlikely. The Children’s Defense Fund has estimated the cost of implementing the new coverage nationwide at $10 billion annually, or a 1.5% increase in the nation’s 1990 health care bill.