Oklahoma high risk pool covers gap in child-only insurance [The Oklahoman, Oklahoma City]

Jan. 25--The board of the Oklahoma High Risk Pool voted Tuesday to provide immediate medical insurance for babies younger than 1, regardless of health.

State officials say the move effectively closes a gap -- sparked by the passage of health care reform -- in coverage under child-only insurance policies, which serve an estimated 4 percent of Oklahoma children who lack coverage under family policies or Medicaid. But some state legislators and child advocates say the fix isn't good enough.

Beginning 18 months ago, when the federal government mandated guaranteed coverage for children under 19 regardless of pre-existing conditions, all insurers in Oklahoma and most nationwide -- afraid of the financial risk especially with critically ill newborns -- refused to write any new child-only insurance polices.

But Blue Cross and Blue Shield and CommunityCare this month returned to the market for child-only policies for children 1 to 19, after Gov. Mary Fallin signed an emergency change in December, allowing insurers to decide at what age they can begin coverage.

The Oklahoma High Risk Pool insures 2,473 Oklahomans, including 125 kids, who pay 150 percent of average premiums nationwide. For coverage, members proved a pre-existing medical condition and denial of coverage by two licensed carriers.

But the high risk pool board on Tuesday waived those requirements for babies under 1, given that there are no child-only policies available to them.

Patti Davis, executive vice president of the Oklahoma Hospital Association, praised the vote.

"We're delighted the pool stepped up to provide coverage for the smallest and youngest Oklahoma citizens," Davis said. "This move enables uninsured, hardworking, middle-class families to secure coverage for their babies and possibly avoid financial devastation if their baby is born with serious health issues."

Oklahoma Insurance Commissioner John D. Doak stressed the pool, managed by Blue Cross and Blue Shield, isn't funded by the government, but by premiums paid by policyholders and assessments paid by Oklahoma's private insurance companies.

Still, Sen. Tom Adelson, D-Tulsa, said he plans to continue to push recently introduced legislation that mirrors laws passed in Colorado, requiring insurers who want to serve the lucrative adult-only individual market to also offer child-only policies.

Insurers should show actual numbers behind their claims that they can't risk covering newborns, Adelson said.

"They're hoisting off that tiny segment because they can," he said. The Insurance Department should have used its "bully pulpit" to include the birth to 1-year-old age group, he said.

Joni Bruce, executive director of the Oklahoma Family Network, who 15 years ago lost a son a few months after his premature birth, disapproves of the high risk pool, and its expensive monthly premiums, as a solution to the problem.

"I believe our state put the interests of insurance companies before taking care of our own most vulnerable citizens," Bruce said. "I am sorely disappointed that our state would even consider not taking care of our babies. They are our future."

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