WORD COUNT 730                                                                                                                                                                            MAY 20, 2009

HEALTH INSURANCE IS LETTING KIDS DOWN – by Marian Wright Edelman

Katie Hebert, age 4, is a very sick girl. She gets seizure-like attacks that can last 11 hours from an undiagnosed neuro-developmental disorder. She is deaf in one ear, has a feeding disorder and requires daily medication for asthma. In her short life, she has been rushed to the emergency room six times and hospitalized twice. She was put at even greater risk when she lost her health coverage—meaning no more regular doctor visits, weekly therapy or attention from specialists.

Katie's father tried, but couldn't afford the roughly $1,000 a month, about 30 percent of his salary, to pay for the plan from his employer. And even if he could have afforded the insurance, it would not have covered all of Katie's needs. Other private insurers would not accept Katie because of her pre-existing conditions.

The only alternative was the Texas Children's Health Insurance Program (CHIP). But her father made $260 a month above the limit that would enable Katie and her older brother, Nathan, 7, to qualify for CHIP. Mr. Hebert is a reliable worker who has helped maintain the computers for a banking system in Pasadena, Tex., over the last six years. He requested a voluntary pay cut in an already modest income so his children could get insurance, but his employer didn't respond. The family eventually spent down its income by paying for unnecessary childcare to become financially eligible for CHIP. That wasn't the end of it, however. When Katie's dad got an automatic 3 percent cost of living raise, the family’s income once again exceeded the CHIP limit, this time by $20.54 a month. While her father went through the process of having his wages lowered, Katie was without health coverage—again.

Katie is one of millions of children in working families who face impossible barriers to obtaining health coverage imposed by insurance companies that make enormous profits and pay their CEOs and top managers fat compensation packages. They decide who gets coverage, what medical treatment they’ll pay for, and how much they pay doctors and hospitals. The premiums these companies charge and these restrictions are major reasons why 46 million Americans are without health insurance—including nine million children.

Insurance companies' massive profits and outsized executive salaries are largely made possible by soaring premiums, high deductibles and rising co-pays that put private health insurance beyond the reach of many moderate- and middle-income families. The 2008 average annual family insurance premium was more than $12,500 or above $1,000 each month. Since 2001, the cost of family coverage from an employer climbed by almost 80 percent, compared with only a 24 percent rise in workers' earnings. Uninsured and underinsured Americans have had to bear the financial burden of high medical costs. About half the people in the United States with homes in foreclosure and a large portion of those who have filed for bankruptcy have named medical expenses as a cause.

There are many ways insurance companies boost their profits while limiting coverage. They routinely deny coverage to people like Katie with pre-existing medical conditions. They also refuse to cover those they think will become ill in the future. Then, the cost of treatment may come to tens of thousands of dollars that must be borne by the family. Individual health insurance policies bought by the self-employed or people not covered through their employer are among the most expensive and restrictive.

These restrictions harm policyholders but swell the bottom line of insurance companies while decreasing the choices of families that work hard and play by the rules. They never get to feel secure that their children will have health coverage from one year to the next. Congress must establish a strong public health insurance plan if we are to give families choices and foster competition in the private health insurance market that will bring escalating costs down. Why should we continue to let children fall into either chasm of profit-driven health insurance companies—some pay their CEOs between $10 million and $30 million annually — or income-restrictive Medicaid and CHIP programs that differ in each state?

Children need help and all of us must act now to ensure that they have access to affordable, comprehensive health coverage. Our fragmented system allows too many to go without. God did not create two classes of children. Our children can’t wait any longer. Let’s make sure Congress hears from us.

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Marian Wright Edelman is president of the Children's Defense Fund and a working committee member of the Black Community Crusade for Children (BCCC). -- A photo of Marian Wright Edelman is available CLICK HERE

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