Obama's Health Care Plan: What It Means for Kids (Part 1)


All this talk of President Obama's upcoming health care summit has moms worried about how health care reform legislation will affect our kids' coverage. And it's no wonder: Because no one knows whether Congress will be able to agree on a final bill, getting straight answers about whether the line to see our pediatrician will get longer or if costs will go up has been nearly impossible—until now!

We asked the head of a leading group of physicians what we can expect from a health care reform bill. You can bet that our brief conversation with her was more helpful than several hours of Internet searching on the topic...


According to Dr. Lori Heim, President of the American Academy of Family Physicians, passage of a health care reform bill this year is highly probably; in fact, the issue is "how, not if." Here, she explains which changes moms can expect in terms of their children's coverage and benefits under a health care reform bill.

CafeMom: If a health care reform bill is passed this year, what will change when I take my kids to the doctor?

Dr. Heim: Certainly health care reform legislation can change in the next several months. However, the House and the Senate each have passed their own health care reform bills. Whether they will agree on legislation that melds the two versions into a final bill is yet to be seen. However, under the two proposals now before Congress:

  • If you have insurance, nothing will change. For example, if your child has a pre-existing condition, health care reform will require insurance companies to provide coverage for that condition. Under the House bill, if your child has a serious or chronic illness, health care reform will prohibit insurance companies from placing a cap on how much they will cover for such conditions. Health care reform also will prevent insurance companies from dropping your child or your family from coverage because the child has or develops a serious or chronic health problem. 
  • If you do not have insurance, health care reform will enable you to buy affordable insurance for you and your family in the individual market. Depending on your family's income, you may qualify for federal subsidies to help you pay your insurance premiums. Once you have insurance, you will use it when you take your child to the doctor for checkups and immunizations. The health care reform legislation requires that insurance companies cover specific services, most notably preventive care such as well-child checkups and immunizations.

Will my kids be denied certain benefits or care that they have had before? 

Dr. Heim:  The legislation sets a minimum of benefits that all plans must have. That's a plus for most people. Depending on the health insurance you have or choose to buy, your children will have at least the same benefits and could have more benefits. Both the House and Senate bills create different categories of health insurance, but the basic plans must provide coverage for:

  • Well baby and well-child care including oral, vision, and hearing services; 
  •  Preventive services such as immunizations; 
  • Maternity benefits;
  • Medical care provided by a physician and care of other health professionals (such as physical therapy) related to medical care;
  • Hospitalization, outpatient hospitals and outpatient clinic services;
  • Prescription drugs and rehabilitative services; and 
  • Mental health and substance use disorder services.

Will I be responsible for any additional costs?

Dr. Heim: Not likely. In the House bill, you would have no cost-sharing—such as deductibles or copayments—for preventive services such as well-child checkups or immunizations, vision, or hearing care.

And, if health care reform passes, your insurance premium is likely to go down. That's because the legislation requires that everyone have health insurance. This means the insurance companies' risk is spread out among more people, so each individual person's premium will go down.  That's why it's important to have the individual mandate that all people have insurance. Spreading the risk among both the healthy and those who get sick keeps the premiums down.

Don't miss Part 2 of our conversation with Dr. Heim tomorrow, in which she addresses what moms can expect when they take their kids to the pediatrician if a health care reform bill is passed.

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