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Los Angeles Times
By Jordan Rau
January 4, 2007
SACRAMENTO — Gov. Arnold Schwarzenegger will propose
that all Californian children, including those in the
state illegally, be guaranteed medical insurance as part
of the health-care overhaul he intends to unveil next
week, according to officials familiar with the plan.
If enacted by the Legislature, his proposal would affect
about 763,000 children who now lack insurance. Although
the administration has not revealed details of how it
would pay for such a program, officials estimate that
extending insurance to all children could cost the state
as much as $400 million a year.
That would be a small piece of Schwarzenegger's stated
goal: to ensure medical coverage for all of the 6.5 million
Californians who now have none. Experts say that could
cost upward of $10 billion a year.
If successful, the governor's effort to cover all children
would be a substantial political feat. Only a few states
guarantee coverage for all those under 18. Schwarzenegger
himself vetoed a measure to cover all children in 2005,
complaining that lawmakers offered no way to pay for it.
California's Republican legislators, who blocked a more
modest effort to extend health-care coverage last year,
are sure to rebel against a plan that includes children
of illegal immigrants.
Schwarzenegger is scheduled to announce his full
health plan Monday. His office is still finalizing many
parts of that package, but aides have made clear that it
will be an ambitious effort to restrain health-care costs
and reduce the state's uninsured population.
All sectors of the health-care industry, including hospitals,
insurers, doctors, patients, businesses and government,
would pay some of the costs under Schwarzenegger's plan.
People familiar with the proposal say that it includes
new requirements for businesses to cover employees, though
the details were unclear. The more cost shouldered by employers
and workers, the less the state would have to spend.
In addition, a number of measures favored by some aides,
such as limiting the profitsof insurers, remain undecided.
"There is no final health plan," said Adam Mendelsohn,
Schwarzenegger's communications director. "As has been
the case from the start, all ideas are on the table and
the final touches are being applied. The administration
is not confirming the inclusion of any one piece."
But several independent sources said Schwarzenegger had
committed to the framework of the children's insurance
portion. Administration officials have privately told people
outside government that they intend to guarantee medical
coverage for children of families earning up to 300% of
the poverty level, or $60,000 a year for a family of four.
Those families have 90% of the children without insurance.
But the cutoff is not yet set in stone.
Schwarzenegger's proposal goes further than one put forward
last month by Senate President Pro Tem Don Perata (D-Oakland).
His plan excluded illegal immigrants. Assembly Speaker
Fabian Nuñez (D-Los Angeles) incorporated children
of undocumented residents into his plan, which also was
announced in December.
"A lot of us are really looking to [Schwarzenegger] for
leadership," said Wendy Lazarus, founder of the Children's
Partnership, a nonpartisan child advocacy group based in
Santa Monica and Washington, D.C. "Assuming he is going
to tell us that he is going to cover all kids, this is
great news for California's kids."
About 90% of California's children already have insurance,
either through their parents' coverage or through state
Medi-Cal programs that help the impoverished. For years,
advocates have been pressing lawmakers to finish the job,
arguing that the electorate would be sympathetic to the
plight of children.
"It's the low-hanging fruit of the health-care reform debate," said
Dr. Bob Ross, president of the California Endowment, a
private foundation in Los Angeles that was created to push
for expanded access to health care.
"Kids are relatively cheaper to cover" than adults, he
said. "From a public health standpoint, it's smarter to
cover all children regardless of immigration. You just
don't want unimmunized kids surfing around in the population."
Such arguments have yet to win the day in Sacramento. Last
year, Schwarzenegger backed a budget plan that would have
helped fund local children's initiatives. Republican lawmakers
blocked the proposal, because it would have included coverage
for children of illegal immigrants.
"We believe Californians do not want to reward illegal
behavior," said Assembly Republican leader Mike Villines
of Clovis. "There are so many here [legally] who are hurting
and trying to make ends meet, we've got to focus on them
first."
The GOP is a minority in both houses of the Legislature,
but most proposals involving state spending require a two-thirds
vote, giving Republicans the power to stop them. However,
it is possible that Schwarzenegger's plan could be molded
to need a simple majority vote, like the last major piece
of health-care legislation to become law.
That measure, a 2003 mandate that most employers provide
insurance for their workers, was repealed by voters the
following year.
Schwarzenegger has taken incremental steps to expand existing
programs aimed at children's health, including the addition
of $80 million to the state budget last year.
Martha Escutia, a former Democratic state senator from
Whittier who pressed for coverage of all children, including
those of illegal immigrants, said Schwarzenegger told her
in 2004 that he agreed with her.
"I said very bluntly that there was no way we could distinguish
between children based on legal status," she recalled Wednesday. "And
the governor agreed. He said, 'Children are children.'
I remember him saying that very clearly."
Sixty-nine percent of Californian children without health
insurance in 2005 were eligible for existing programs but
were not enrolled, according to the UCLA Center for Health
Policy Research.
That was due to a variety of factors, including inadequate
funds in some county programs to cover all those who qualified,
and some of the bureaucratic requirements for entering
state programs.
Many parents, for instance, are required to prove that
their earnings are low enough to qualify their children.
There is disagreement about how many of the uninsured children
are here illegally. A 2003 UCLA survey said that 33% were
not citizens, but that does not mean that they were in
the country illegally. Ross, of the California Endowment,
said the number was below 15%.
Most of the other states that already guarantee coverage
for all children do it through state-paid programs for
those from poor families, and by allowing better-off families
to cover their children by paying a portion of the costs
for the same programs.
Typically, the more a family earns, the more it pays. Connecticut,
Illinois, Maine, Maryland, New Hampshire, New Jersey and
Vermont all have such programs.
Lazarus, of the Children's Partnership, said that although
California would not be the first to cover all children,
it has fewer employers providing insurance and more illegal
immigrants than other states, making coverage more challenging.
"For California to step up at this time when states and
Congress are really focused on health-care reform means
that California could have a really significant leadership
role across the nation," she said.
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