States, Not Feds, Tending to Nation’s Uninsured Children

It’s inspiring, truly, that everyone in Washington is so concerned about the health and well-being of the 93 teenagers who serve as pages each year for the House and Senate.

But it would be nice if the nation’s political leaders could spare a moment for another 8,310,000 young people who appear to have escaped their notice.

That, according to the Census Bureau, is the number of children younger than 18 in America who lack health insurance.

Until recently, children had been a bright spot in a dismal healthcare picture. Since President Bush took office, the total number of people in America without insurance has jumped from 39.8 million in 2000 to more than 46.5 million in 2005. The percentage of people receiving healthcare through their employer has dropped every year since 2000.

Children haven’t been immune to that trend. The share of children receiving healthcare through their parents’ employer has also been falling. But until last year, government had stepped in to offset those losses.

From 1998 through 2004, the number of children enrolled in Medicaid (a state-federal partnership for the poor) and the Children’s Health Insurance Program (a state-federal partnership for children in working poor families) swelled by more than 5.6 million. That expanding public safety net steadily reduced the number of uninsured children, despite the continuing erosion of employment-based coverage.

In 2005, the latest year for which figures are available, that relatively benign picture darkened. Employment-based coverage for kids continued its decline. But with state budgets squeezed, the number of children receiving insurance from public programs also fell. These twin retrenchments produced a jump of nearly 400,000 in the number of uninsured children -- the largest annual increase since 1995.

Most Americans would probably be surprised by the profile of the 8.3 million kids without insurance. Nearly nine in 10 live in families where at least one parent works, according to a recent study of census data by Families USA, a healthcare advocacy group. Nearly six in 10 live in two-parent families. Almost a third of uninsured kids live in families where both parents work.

Less surprising are the consequences of lacking insurance. Analyzing another government survey, the report found that children without insurance were much less likely than those who were covered to receive regular check-ups, and much more likely to have unmet medical needs. Children without coverage were three times more likely than insured kids to go an entire year without seeing a doctor.

These trends have provoked little discussion in Washington, where Bush and Congress have failed to agree on any serious steps to reverse the rise in healthcare costs and the decline in access. So the initiative is shifting to innovative states. “A lot of these efforts are born out of frustration with Washington,” said Ron Pollack, executive director of Families USA. “It’s like, we can’t continue to wait for Godot.”

Illinois, under Democratic Gov. Rod Blagojevich, has launched a program that allows all parents to buy subsidized insurance for their children, with premiums set at a sliding scale based on income. As part of the universal coverage plan that Massachusetts’ Republican Gov. Mitt Romney signed this year, the state will insure through Medicaid all children in families earning up to three times the poverty level (about $60,000 annually for a family of four).

Bill Richardson, the Democratic governor of New Mexico, this year pushed through a plan ensuring access to insurance for kids 5 years of age and younger and said that if reelected, he would extend coverage to adults (partly by requiring employers doing state business to provide insurance).

In November’s election, the crucial healthcare battles are being fought over ballot initiatives in California and Missouri.

In both states, broad coalitions of public health advocates are pushing for tobacco tax increases to finance expanded coverage. The Missouri plan, known as Amendment 3, would raise tobacco taxes 80 cents a pack, mostly to cover more low-income kids and adults. The California proposal, Proposition 86, is more ambitious: It would raise taxes $2.60 a pack to provide access to insurance for the estimated 800,000 children in the state without it.

These efforts dramatize both the possibilities and the perils of expanding coverage at a state level. If the initiatives succeed, they could send “a signal nationally” that encourages other states and eventually Washington to act, notes Wendy Lazarus, founder of the Children’s Partnership, a leading sponsor of the California proposition.

The problem is that, compared with Washington, states have more limited revenue sources to finance expanded coverage for kids. That has led advocates in Missouri and California to focus on tobacco taxes (which carry the added public health benefit of discouraging smoking).

But by targeting cigarettes, they have stirred a ferocious counterattack from the tobacco industry. The Missouri amendment is faring better in polls than its California counterpart, but neither is guaranteed to survive the barrage of advertising the tobacco industry is funding in each state.

From both a policy and a political perspective, it probably doesn’t make long-term sense to rely so heavily on one industry -- even one so culpable for compounding the burden of death and disease -- to fund more healthcare coverage.

Guaranteeing insurance for all kids should be a national priority, with a national solution and a broad funding source. States are taking important steps, and could take more in November. But until Washington commits to the cause, America will continue to live with the shame of denying reliable healthcare to one in every nine of its children.

ronald.brownstein@latimes.com