Individuals with Special Needs and Health Reform: Adequacy of Health Insurance Coverage

From David Evans, Executive Director
Austin Travis County Mental Health Mental Retardation Center:

Last week the Kaiser Family Foundation released an issue brief examining how individuals with complex health care needs might fare in a reformed health system. The report, Individuals with Special Needs and Health Reform: Adequacy of Health Insurance Coverage , analyzed healthcare coverage for three individuals and cost sharing requirements to the Blue Cross Blue Shield Standard Option plan offered to Members of Congress and federal workers under the Federal Employees Health Benefits Program (cited as benchmark under a reformed health care system), and also takes into consideration Medicaid coverage.

What this study shows is that coverage for persons with complex health needs may be significant and broad - still containing cost provisions that are beyond the financial reach of middle class workers. They offer examples of disabilities that require treatments which could range up to $12,000 annually and out of pocket expenses from $21,000 to $32,000 for long-term care costs under such plans.

This study adds an important dimension to policy issues for people who would have health insurance coverage extended to include them - what benefits does that coverage include? The question cannot be answered accurately without careful examination of cost sharing and out of pocket expenses. To view and download the report, go to: http://www.kff.org/healthreform/upload/7967.pdf .