As policymakers put the final touches on health care legislation that would expand coverage to millions of Americans, it is important that they ask themselves, "Coverage for what?"

Two new reports from the Georgetown University Health Policy Institute and the Kaiser Family Foundation tackle this question head on, looking at health coverage for children and individuals with special needs. Both groups require specialized care. The reports analyzed how insurance coverage differs between a benchmark private plan and public programs. Read the full reports, respectively, here and here.

Their key findings, from last week’s discussion, Matching Health Benefit Packages to Health Needs: Key Issues to Consider in Health Reform, are interesting:

Individuals with Special Needs and Health Care Reform:

• The medical needs of individuals with special needs are diverse, complex, specialized and life-long
• Medicaid offers comprehensive coverage with little or no cost-sharing
• The typical private plan falls short in providing necessary long-term services and support for individuals with disabilities and chronic conditions

Children and Health Care Reform:

• Children have unique health care needs (e.g. vision, dental, hearing) that are often limited or excluded from private plans. Appropriate health care can help children avoid preventable and serious conditions as well as promote nutrition and physical activity.
• Even families with relatively healthy children will face high medical bills under a typical private insurance plan
• Children with special needs face coverage gaps and high medical bills under private coverage; often families will put off children’s preventive care
• Medicaid fully covers children’s acute care and long-term needs with limited or zero cost sharing

While private plans offer generous benefits for acute problems, the public plans are better able to accommodate individuals with long-term conditions, children and low-income families/individuals. Yet while benefit packages in Medicaid may be more comprehensive, funding issues can create significant barriers to care.

Clearly one size does not fit all in health care. Which is why we are pleased that reform proposals in Congress place such an emphasis on creating more options for Americans to get the health care coverage they need.

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