Visit our new Health Care Reform Law web page to track what is happening locally and nationally. Data Updates 2009 Children's Health Insurance Enrollment + 9,647 QUEST and QExA + 410 HMSA Children's Plan 2009 Hawaii Hospital Emergency Department Data: Uninsured Kids Ages 0-17 Years Old 3,015 Total Number of Visits $1,109 Average Hospital Bill $3.3 Million Total Hospital Bills 1. Hawaii: Kids Covered Longer Children can stay on their parents' health plan longer, but at what cost? By next year, adult children-even college graduates-can be taken into their parent's health care plan thanks to the new health care reform law. Starting in 2011, health plans will offer health care coverage for adult children until they turn 26 years old. Until now, kids have been booted off parental insurance once they finished college. "You might have a lot of folks in that category who work only part time, who only go to school part time," said Jennifer Diesman, vice president of government relations at the Hawaii Medical Service Association. As it is written, the law has few restrictions. It does not define a dependent in the same terms as the tax code does. That means the child could be covered regardless of whether he or she lives at home, owns a home, is married, or has children. Congress originally passed the bill with a restriction against married children, but an 11th-hour budget reconciliation bill that passed in addition to the main legislation made marital status irrelevant. The only exception is for children who already have employer-sponsored insurance. Hawaii already mandates insurance for people who work more than 19 hours a week. The law also does not apply to grandchildren. Adults ages 19 through 29 have the highest uninsured rate of any age group in the U.S., comprising of more than 30 percent of the overall uninsured population, according to the Henry J. Kaiser Family Foundation. There are 25 states that have increased the age at which children can be covered, usually up to 25, but many of the state laws apply only to full-time students. The dependent coverage extension will not kick in until January 2011. This gives local health insurance providers time to study the law and reorganize their plans. Currently the state's two largest providers-HMSA and Kaiser Permanente Hawaii-offer dependent coverage for adult children, but with a number of requirements. At HMSA, different groups have a specified student maximum age, and the child must not be married. If the child is 19 or older, they must be a full-time college student and must be wholly dependent on the parent for financial support. Diesman said many of the company's plans have a maximum age of 25. Kaiser Permanente also offers student coverage with restrictions up to age 24. Kaiser spokeswoman Lynn Kenton said that if an employer offers another plan with a higher age cap, Kaiser will match the age eligibility. Kaiser also recently started its Bridge Program, which offers free insurance up to a year for people between 19 and 24. They must not be eligible for Medicare, Medicaid or QUEST, must live on Oahu, and must meet certain financial eligibility requirements. "It's a great program for students who might not have insurance," Kenton said. Kenton and Diesman said their respective companies are reviewing the 2,400-page law and seeing where changes need to be made. Nationally there is concern that premiums may rise because of the extended coverage. Locally, Diesman said the change will be less significant because all employers offer coverage for full-time employees. Although she could not comment on how local premiums will be affected, she said young adults are a lower-risk age group and draw less from the insurance pool by needing less medical attention. "Any time you can bring younger people into the health coverage pool is a good thing," she said. "Generally speaking, younger folks have lower health care risks, use less health care services. So they can contribute positively to the overall pool." [Gene Park, Honolulu Star-Bulletin, 04/18/10] 2. National: Three Insurers Move Up Age For Young Adult Eligibility U.S. Department of Health & Human Services Secretary Sebelius has announced that three major health insurers have agreed to let young adults stay on their parents' plans after they would normally lose their eligibility. Blue Cross Blue Shield plans, Kaiser Permanente and Humana, she said Tuesday, have adopted the new health care law's higher age limit before they're required to at the end of September. Sebelius has been encouraging insurers to step up ahead of that deadline. Carriers have traditionally allowed young adults to stay on their parents' plans only until they graduate college, and that has pushed many onto the ranks of the uninsured, if they haven't found jobs that offer coverage. "The Affordable Care Act, and the voluntary actions of insurers to eliminate the coverage gap for young adults on their parents' plans, will give greater health security to millions of American families," Sebelius said in a statement. "Insuring younger Americans is a top priority for the administration and we will continue working to expand the opportunity for children and young adults to have access to quality, affordable care." "The entire Blue Cross and Blue Shield system, which provides coverage to nearly 100 million Americans in every ZIP code in the nation, is committed to working collaboratively with the administration, Congress, state regulators and all stakeholders to provide for an effective and workable implementation of the new health care reform law," said Scott P. Serota, BCBSA CEO. "By proactively making this change now, Blue Cross and Blue Shield plans are working to enhance and preserve coverage for as many Americans as possible." The Blues plans will make the coverage available to those insured through their employer accounts. [Marilyn Werber Serafini, CongressDaily, 04/22/10] 3. National: Early Wins for Children and Families in Health ReformCenter for Children and Families released a new issue brief (http://ccf.georgetown.edu/) that looks at some of the most immediate changes in health reform for children and families. While many of the sweeping changes to the insurance industry and other major provisions do not go into effect until 2014, children have some much earlier "wins" to look forward to. High on the list of early benefits from the legislation is the strengthened opportunity families now have to enroll their uninsured children in Medicaid and CHIP. Out in the "real world," where people don't have time to read legislation, many families are seeking information on what the law means to them today. This creates an opportunity to raise awareness among eligible families that their children can obtain coverage through Medicaid and CHIP. Let's not forget the experience in 1997 when CHIP was created with the excitement of the new law many new families came forward to enroll in coverage, only to find out that they were already eligible for Medicaid. In addition, health reform includes two provisions to assist families in obtaining health insurance. States are required to "hold steady" when it comes to Medicaid and CHIP for children until October 1, 2019 so families can count on the coverage being there when they need it. In addition, the U.S. Department of Health & Human Services must set up a new web portal by July 1, 2010 to provide information to families on state-level health insurance options. A boost in enrollment, or as we like to call it the "welcome mat effect," could be a potentially powerful tool for increasing the number of insured children in the nation and setting the stage for health reform. Other health insurance reforms discussed in the paper that quickly go in effect include: * By July 1, 2010, uninsured children and families with pre-existing conditions can seek coverage through newly established 50-state high-risk pools. * For health plan years beginning after September 23, 2010, everyone signing up for a new health plan will receive preventive services at no cost, insured children cannot be denied coverage for a pre-existing condition, and young adults up to age 26 can obtain coverage through a parent's plan. * New health insurance reforms make it easier for people to use and keep their insurance (various implementation dates). While we have to wait until 2014 to see some of the more dramatic changes to how people receive health coverage in this country, these early reforms are "not anything to sneeze about" and, in fact, could have a real impact on the lives of children and their families. [Dawn Horner, Say Ahhh!, 04/13/10]