California Can Show the Way

Sometimes you get lucky.

The California Legislature worked into the wee hours of its closing session to enact a visionary new plan for children’s health insurance. This landmark legislation, called Healthy Families, offers health coverage starting July 1 to hundreds of thousands of uninsured children whose parents work at low-wage jobs.

California’s plan has the potential of becoming a model for the nation and sets the stage for our state to embark on one of the most ambitious and important experiments ever to affect our children. But the challenges in making this vision work are formidable.

The legislation literally asks us to reinvent how we insure children. The task will require the very best strategic planning, cooperation and program management that Californians can muster. Just as drafting a strong business plan does not necessarily result in a profitable business, the success of this children’s health initiative is not guaranteed. State and county health officials, health plans and providers, community-based organizations, parents and many others will have to come together in unprecedented ways to make this legislation work for kids.

For one thing, the scale of this effort is daunting. Of California’s 9 million children, 1.6 million have no health care coverage. Healthy Families is slated to enroll nearly 600,000 of these uninsured children. But getting the word out about this new program and simplifying enrollment procedures enough to get all 600,000 kids enrolled will be difficult. California’s Medi-Cal program, which currently fails to enroll roughly 25% of eligible children, provides a harsh lesson in the difficulties of this challenge. Aggressive outreach by churches and other organizations in low-income neighborhoods and a streamlined application procedure will be crucial.

California has also chosen to increase coverage for children through private insurance plans rather than expanding the public Medi-Cal system. These are untested waters. Private plans typically do not market to or serve the low-income population and employer-based plans are increasingly dropping children. It will not be easy to engage private insurance in ways that build the insurance market for kids rather than further erode it. Appropriate benefits, use of community clinics and public hospitals familiar to low-income families and culturally sensitive practices will all be key.

One new and extremely delicate aspect of implementing this program is how the health plans are marketed to eligible families. Consumers have been the target of fierce marketing efforts for cars, computers, or appliances--all promising us a better product at lower cost. But the technicalities of a health plan are complicated, and low-wage working parents have not had experience sorting through these differences. When it comes to costs and family cost-sharing requirements, choices offered, services covered and other complicated plan features, parents will need simple information that compares all the plans. The state administering agency will need to ensure the accuracy of the marketing information.

The legislation also requires that families contribute a monthly premium and co-payment for each physician visit and prescription. This must be set at an affordable level for eligible families and must be monitored and adjusted if necessary. Similarly, the connection between Medi-Cal and the new Healthy Families program must be coordinated because changes in parents’ employment and income mean that many children will lose eligibility for one program during the course of a year. Since the most important health benefit for kids is that they have a regular clinic or doctor to go to, ensuring continuity between the two programs will be essential.

Healthy Families has the potential to bring health care within the reach of all children in California whose parents work hard and play by the rules.

We face important choices in implementing this legislation. If we’re successful, our health care for kids will be a model for our nation. If we fail, some may wonder if we were wise to gamble the health of our children on an experiment.