HEALTH COACH - Jimmy Kimmel opens the light on the health cover for infants with birth defects

HEALTH COACH - 
 Jimmy Kimmel opens the light on the health cover for infants with birth defects  

 "It is unfathomable, then, that we can make things worse by limiting or removing child health care coverage." 
 
 About 40,000 infants are born each year with a heart defect. The one who hit Mr. Kimmel's son is called Fallot's Tetralogy with a pulmonary atresia; It affects about seven of every 100,000 babies born alive and accounts for 2 percent of all congenital heart defects. 
 
 The situation is hard to miss: the child is often born of blue because the passage from the heart to the lungs is completely blocked. The blood can not reach the lungs, where it would be oxygenated. 
 
 The infant is alive only because a passage in the lungs during the development of the fetus remains, allowing blood to pass. It will close, however, and the condition can be fatal without immediate intervention, which can cost $ 100,000. 
 
 About 90 percent of these children will survive until the age of 18, but initial surgery is only a temporary solution. Doctors generally have to work several times over the years. And people with the condition need regular care of experts. 
 
 "This is a lifetime disease," said Dr. Yuri Kim, director of the Adult Congenital Heart Disease Center at the University of Pennsylvania. 
 
 Prior to the enactment of the Affordable Care Act in 2010, federal legislation required employer sponsored plans to cover newborns regardless of their state of health as long as their parents had them Enrolled within 30 days, said Karen Pollitz, member of the Kaiser 
 
 
 If parents have changed jobs, their new insurers could not impose waiting periods or bill More for sick newborns. 
 
 But things were different for parents who purchased their insurance individually. 
 
 All 50 states had laws requiring newborns to be covered by a parent's insurance policy and no longer billed if they were sick. And were enrolled within 30 days. But if a parent has changed plans after the birth of a baby, the new insurer may refuse to cover care for a sick infant for an initial period or to charge more, said Mrs. Pollitz. 
 
 They could also do so if parents were not insured to begin with. 
 
 The lifetime limits of coverage were also a problem. In individual and employer-sponsored plans, some severely affected children have met the policy limits in the early years of their lives. 
 
 Ms. Pollitz pointed out, however, that nearly half of all newborns were and are still insured by Medicaid, "which basically says no matter what the need of the child." Many infants with serious congenital defects also require home care as part of the program.  
 
 
 Under the Republican bill to revoke and replace, the biggest concern for seriously ill newborns may be a reduction of the Medicaid program. The Republican plan would give states the choice between a fixed annual amount per beneficiary or a block grant, one or the other of which would almost certainly result in major limitations on coverage over time. 
 
 The bill would also allow states to withdraw from several consumer protections, including the prohibition of the Affordable Medicines Act on insurance companies from paying higher premiums to people Having pre-existing medical conditions. 
 
 This could affect roughly 8 percent of Americans who rely on the personal insurance market, but only if they had been uninsured for 63 days or more. last year. 

 As part of this plan, families with sick children who rely on individual coverage "should be meticulous in registering at every open registration and never fail to pay," said Ms. Pollitz. 


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 "A shift, and you are back in the pool subscribed again and could be charged an unaffordable amount." 
 
 The Republican bill would also allow states to allow insurers to offer more overwhelming coverage than the Affordable Health Care Act requires, 39 small tax for many Americans. 
 
 "You are going to have some level of income to even be able to pay for coverage in the first place," said Sabrina Corlette, a research professor at Georgetown University. 
 
 At the moment, parents of newborns with severe heart defects are struggling for care. 
 
 Ideally, infants with congenital heart disease receive surgery at specialized medical centers, said Dr. Gerald Marx, a pediatric cardiologist at the Boston Children's Hospital, who performs about 1,400 of These operations each year. The results are better if the surgeon and the medical center are very experienced. 
 
 All states do not have specialized congenital heart centers, but families often have insurance policies that do not cover medical care outside their condition. 
 
 "When the insurers do not pay it, very tragically, they eventually do not come," Marx said. 
 
 The worried future Elizabeth Swift, of Billerica, Mass., Whose son, James, aged 7, was born with the same cardiac defect as the son of Mr. Kimmel. 
 
 She and her husband were so stressed and distracted after her birth and her open-heart surgery, they missed the 30-day window to inform their insurer to guarantee coverage. The insurance company refused to cover the care of their son. 
 
 "I was getting bills for hundreds of thousands of dollars in the mail," she said. "I just shouted and said," I can not deal with this now. "
 
 Eventually, she managed to get coverage for her son from the state. When the Affordable Care Act was passed, her husband's company insurance agreed To cover James. 
 
 Now she is worried about what could happen to James' s insurance and to that of other children with serious congenital defects if the bill 
 
 What if legislators restore the ability of insurers to impose lifetime limits on the amount they will pay? What could happen in the long run after James will turn 26 and Can no longer be covered by the insurance of his parents? 
 
 "I pray," Swift said. 
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