Expansion of mandated health benefits urged

March 08, 1991|By Ross Hetrick | Ross Hetrick,Evening Sun Staff

Even as state-mandated health benefits come under their severest attack in years, scores of people urged legislators to add four more such benefits.

The appeals were made yesterday before the Economics Affairs Committee in the House of Delegates. If the proposals are enacted, health insurers would be required to provide coverage for the preventive care of children, care for new born and newly adopted children, treatment for certain types of mental illnesses, and mammography to detect breast cancer.

Mandated benefits, which are generally praised by doctors and scorned by insurers and businesses that pay for them, require health insurance companies to provide certain services to all subscribers. These benefits include procedures such as transplants, in vitro fertilization, mental-health care and substance-abuse treatment. In total, there are 32 mandated benefits, one of the largest number required by state law in the country.

However, these mandated benefits are not required for health-maintenance organizations or businesses that are self-insured.

In one of the most serious challenges to that system, the General Assembly this year is considering a scaled-back health package that would be within the reach of many of the 570,000 Marylanders who do not have health insurance. But state's mandated benefit requirements would be stripped from that program.

One consumer group has said that the plan would undermine mandated benefits while still being too expensive for many uninsured people.

Despite the threat to mandated benefits as a whole, proponents of the new requirements say their proposals are essential for the health of Maryland's population.

The bill that would mandate "wellness services" for children, which includes immunization shots, is necessary to prevent previously eradicated diseases from reappearing, according to Dr. Robert D. Brodell, president of the Maryland Chapter of the American Academy of Pediatrics.

He said the recent reappearance of some diseases is "strictly because immunization are not being carried out." Brodell and other supporters of the bill said state studies have found that 59 percent of the pre-school children are not getting the needed immunizations. Children are required to be to get immunization shots before they enter public schools.

By making such shots and other preventive treatments for children part of insurance policies, parents would be more willing to have their children treated, supporters of the bill said.

However, Fran Tracy, vice president of government affairs for Blue Cross and Blue Shield of Maryland, doubted that the mandated benefit would solve the problem of low pre-school immunizations. "I believe parents are the problem and I don't think we can mandate appropriate parental behavior," she said.

She also said immunization shots are already free through local health department clinics in Maryland to anyone, regardless of income. However, there are sometimes an administration fee, which is charged on a sliding scale, Tracy said.

"Where is their [government's] responsibility in publicizing the availability of these services," she said.

The new mandated benefit would add an extra $6 per month to the health insurance bill of each subscriber. For state employees alone, this would cost $207,000 annually, Tracy said.

She also questions the urgency for more immunization, citing a federal report that said 97 percent of the children entering first grade in the entire nation have immunization shots. But that position was challenged by supporters of the bill on the committee.

Tracy also opposed a proposal to mandate coverage for certain "brain diseases," saying it would add another $26 million to the bills of Blue Cross' 350,000 group contracts.

Supporters of the benefit want expanded coverage for certain types of severe mental illnesses, which include schizophrenia, schizo-affective disorder, bipolar disorder, and major depression.

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