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Los Angeles Times
By Juliet Chung
June 9, 2006
Every youngster in California would qualify for
health insurance if a bevy of legislative proposals
and local efforts goes forward, creating what advocates
say is the most promising moment in years for children's
healthcare.
In his revised budget, Gov. Arnold Schwarzenegger has proposed spending $58 million,
which would draw nearly as much in federal matching funds, to expand children's
health coverage.
And a tobacco tax initiative expected to qualify for the November ballot would
offer long-term funding for universal children's coverage.
These and other proposals would cumulatively provide insurance to the nearly
800,000 uninsured youngsters in the state under age 18, including those who are
undocumented.
"This is the strongest push that I've seen, period," said Wendy Lazarus,
a longtime children's healthcare advocate who founded the Children's Partnership,
a sponsor of the tobacco initiative. "This is a once-in-a-generation opportunity
to take care of the health insurance problem for kids."
Some parents are equally enthusiastic, saying universal coverage would provide
welcome relief.
"My husband would not have to kill himself working so much," said Los
Angeles mother Fabiola Lopez, referring to the out-of-pocket fees she and her
husband pay to get medical care for their undocumented children.
Universal coverage for children has broad popular support. A United Way poll
released last month found 83% of California voters in favor of a state proposal
to "ensure every child has health insurance." It ranked public support
for children's coverage above increasing funding for K-12 education--traditionally
one of the most popular issues with voters, said pollster Ben Tulchin, who conducted
the survey.
Currently, a jigsaw puzzle of insurance programs covers slightly more than 9
million children, more than 90% of the youngsters in the state, according to
2003 data from the California Health Interview Survey.
Medi-Cal, the state's version of Medicaid, provides free insurance to children
of the poor. The state's Healthy Families program covers children mostly from
working families that cannot afford private insurance. Neither covers undocumented
children generally, though Medi-Cal covers emergency services.
In an increasing number of counties, local programs, funded by public and private
money, cover children who don't qualify for Medi-Cal or Healthy Families. Undocumented
children who need nonemergency care, for instance, can be covered under these
plans.
Undocumented children constitute at least 12% of uninsured children in California,
said E. Richard Brown, director of the UCLA Center for Health Policy Research.
Of the total number of uninsured children, about half are eligible for Medi-Cal
or Healthy Families but are not enrolled; experts say the complexity of applying
or determining eligibility deters many parents. The rest are ineligible for either
program and may not have access to local programs.
Proposals for bridging these gaps in coverage include:
- The tobacco tax initiative, which would raise
the tax per cigarette pack by $2.60 to $3.47
to expand Healthy Families. Children in families
earning up to almost $60,000 a year for a family
of four would be eligible for coverage; the current
cutoff is about $50,000 for a family of four.
Undocumented children in families meeting the
income requirement would also qualify.
- A Senate bill that calls for a statewide insurance
program, California Healthy Kids, under which
Medi-Cal and Healthy Families would operate.
Application procedures for families would be
simplified to help children get and remain enrolled.
- A $40-million Assembly proposal that would
boost funding for local programs. Eighteen counties,
including Los Angeles, San Francisco and Riverside,
have founded such programs since 2001, and other
counties are planning to.
Healthcare providers and children's advocates
say coverage during children's formative years
is critical. Preventive care is less expensive
than treating chronic illness, they say, and good
health can improve children's performance in school.
Children are also relatively inexpensive to insure,
costing about $1,100 per year compared with roughly
$4,000 or $5,000 for an adult, according to experts.
Peter Long, director of research and planning for
the California Endowment, a healthcare foundation,
said California is benefiting from growing interest
in locally funded programs as well as from the
pioneering efforts of Illinois, which passed legislation
last fall guaranteeing universal children's health
coverage.
"What's stopped a lot of healthcare reform discussions is they're academic;
people inevitably ask, 'Can it work in practice? What does it mean in real
life?' " Long said. "These [local] children's health initiatives
show that, on the ground, it works."
Jim Keddy, director of the faith-based group PICO
California, which advocates for increased access
to healthcare, said the momentum toward universal
coverage was growing. Many children already are
covered, he said, and the state budget is less
tight than in recent years.
"We consistently were hearing, 'Well, that's a terrific idea, but we can't
afford it,' " Keddy said. With this year's budget windfall, "Now,
people are saying, 'We have some flexibility. How should we invest these dollars?' "
But in Sacramento, some legislators questioned
the wisdom of spending taxpayer money on insuring
illegal immigrants.
"If they're here illegally, they're not the financial responsibility of
the state of California," said state Sen. Dave Cox (R-Fair Oaks), who
sits on the Senate's Health Committee. "Providing healthcare for everyone
is just a financial burden that this state can't sustain."
Assembly Speaker Fabian Nuñez (D-Los Angeles)
disagreed, saying universal children's coverage
would be a wise investment in California's future.
"If we want to have a well-trained, well-educated workforce to take on
the challenges of the 21st century," he said, "their health is of
utmost importance."
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