But a key piece is missing, Ann Fullington says. The policy offers very little help in paying for hearing aids. Indeed, many Washington plans refuse to pay for the sometimes life-altering equipment.

"The really crucial piece that (5-year-old Emily) needs ... they just pay this pittance on; and we are fortunate that they pay a pittance," said Fullington, a part-time tax professional. Fullington said her daughter's hearing aids run $3,000 to $3,500 a pair and have to be replaced every few years. In addition, the family has spent hundreds on ear molds, batteries and other accessories. "My husband's got this amazing health insurance, but it's just crazy that somehow hearing aids have been excluded."

Parents such as Fullington and advocates for consumers, seniors and children want state legislators to require insurance companies to cover hearing aids on the same terms they do prosthetic devices. Insurance companies and small-business lobbyists complain that such a standard would be adding yet another costly mandate to a list of dozens of items that jeopardizes employers' ability to provide health coverage for their workers at all.

"It adds costs -- and right now the small-business community is having a terrible time being able to afford health care costs," Gary Smith, director of the Independent Business Association, told legislators at a recent hearing in Olympia. "If we increase the cost of health care insurance, you'll have fewer people with health care insurance."

State budget officials estimate that, when fully enacted, House Bill 1336 would cost taxpayer-funded health plans nearly $4.3 million a year. Eleven other states are considering similar legislation, according to a national health policy tracking service.

Proponents of the bill say it's unfair that there are protections for patients who need wheelchairs and hospital beds for home use, but not for the deaf. And they say the investment pays off by helping the hearing-impaired succeed in school and in the workplace. The short-term expense would protect many -- particularly the elderly -- from the depression, isolation and general health deterioration that can accompany hearing loss, backers of the bill say.

"We don't want to drive up health care (costs), either," said Penny Allen, a 60-year-old from Port Orchard who has experienced progressive hearing loss for two decades and has spent more than $20,000 out of her own pocket on hearing aids and related equipment, despite having employer-sponsored insurance. Allen now has profound loss and is a grass-roots leader of the effort to get the measure passed. "Our biggest gripe is we see wheelchairs (and other such equipment) covered. Hearing aids are the same things to us."

"We represent a lot of people who are retired and working and children, and nobody needs more health care costs," Allen said. "But we feel it should be equitable."

Business and insurance interests say they're sympathetic. But they're drawing a line. "We have been reluctant in almost every case to endorse new mandates," Rick Wickman, a lobbyist for Premera insurance, told a legislative committee last week.

Proposals to expand coverage requirements are pitched virtually every year in Olympia, usually by Democrats and consumer groups. For example, this year, lawmakers are considering requirements that insurers pay for early cancer screening and mental health treatment. In previous years, patient advocates and professional industry groups won requirements that carriers cover services from chiropractic care to mammograms, newborn health screenings to alternative medicine. Usually exempted are policies sold to individuals not covered through work and the self-insured plans used by many large employers.

And, most years, businesses, insurance groups and some Republicans push for repeals and further exemptions of some of those mandates. They argue that employers ought to be allowed to provide their workers with less generous benefits; otherwise, more employers will be forced to drop coverage altogether.

But Karin Cook of Shoreline would like the two sides to consider the incalculable rewards of providing the hearing impaired, such as her 13-year-old daughter, Ashleigh, with the technology they need.

Cook, who works in medical billing, says she has spent more than $20,000 on hearing equipment for Ashleigh, whose loss is severe to profound. As Ashleigh grows, she continually needs new ear molds or the hearing aids will squeal so loudly it's audible to those around her. As her hearing progressively deteriorates, she needs new hearing aids. In eight years, the Cooks have spent $900 on batteries, she said.

After Cook's grandfather died last month, her stepmother asked if Ashleigh could use his old hearing aids. She couldn't.

"I'm not just fighting for children," Cook said. "It's going to affect every family in the state of Washington."

By Angela Galloway