HB 1160 -- HEALTH INSURANCE

SPONSOR:  Parker

COMMITTEE ACTION:  Voted "do pass" by the Committee on Financial
Services by a vote of 19 to 0.

This bill changes the law regarding health insurance coverage for
phenylketonuria and any inherited disease of amino and organic
acids.

Currently, this type of health insurance coverage must be
provided for a patient who is covered and is less than six years
of age.  The bill repeals the requirement that a patient be less
than six years of age.

In addition, current law requires the insured to be responsible
for a reasonable co-insurance or copayment which would not exceed
50% of the cost of formula and food products used to treat the
diseases.  The bill repeals this provision.

The bill also prohibits the insured from being subject to any
greater deductible or copayment than other similar health care
services provided by the policy, contract, or plan.

FISCAL NOTE:  No impact on General Revenue Fund in FY 2005, FY
2006, and FY 2007.  Estimated income on Other State Funds of
$8,000 in FY 2005, $0 in FY 2006, and $0 in FY 2007.

PROPONENTS:  Supporters say that these diseases are life-long
illnesses, not something that affects only children, as was the
theory 40 years ago.  Without the prescribed formula and
low-protein modified food products, people with these diseases
suffer irreparable brain damage and, ultimately, death.  Adults
who don't get the formula and special foods will slowly lose
their mental capacity and must be institutionalized, costing the
state much more than the formula and special foods.  Formula
alone for one child costs more than $1,000 a month, and specially
prepared foods generally cost five to eight times more than
regular food.  This forces many families to sell their home and
assets in order to be eligible for Medicaid.  A change to the law
in 2002 has been interpreted to cut off coverage for formula at
age six, but that was never the intent and must be corrected.

Testifying for the bill were Representative Deeken; Aimee
Jokerst; Amy Conant; Lois Kidwell; Ed Madden; and Marcia Hubbard.

OPPONENTS:  Those who oppose the bill say that insurance
companies are opposed to any kind of additional mandated health
insurance coverage.

Testifying against the bill was Blue Cross/Blue Shield.

OTHERS:  Others testifying on the bill say the insurance industry
did not intend for anyone to lose coverage for formula after age
six.  In fact, no insurer is interpreting the change in that
fashion.  The only entities interpreting it that way are the
departments of Social Services and Transportation.

Others testifying on the bill was United Healthcare.

Richard Smreker, Senior Legislative Analyst

Missouri House of Representatives
92nd General Assembly, 2nd Regular Session
Last Updated September 23, 2004 at 11:14 am