Money is Available for the Uninsured

California’s 7 million uninsured residents--one in every four non-elderly residents--face a tough challenge. They can’t afford health insurance coverage but without it, they can’t afford to see the doctor. And the problem is getting worse, as 50,000 more residents become uninsured each month. But California also has an extraordinary opportunity, passed up by former Gov. Pete Wilson, to get generous federal help.

Why are so many Californians uninsured? Although more than 80% of all the uninsured are workers and their families, health insurance is either not available from their employers or unaffordable or both. And many lost Medi-Cal coverage as they went from welfare to work.

One in every five employees works for an employer who does not offer health insurance to anyone--a rate one-third higher than for the rest of the nation. Among uninsured California employees, more than 70% work for an employer who does not offer health benefits at all. Further, many workers are offered insurance that is unaffordable. Most low- and moderate-income employees cannot afford the average $1,800 annual premium. It’s tough even for middle-income workers to privately purchase individual coverage at an average of $2,000 annually or family coverage for $5,000.

The uninsured pay a high price. They receive less essential care for chronic health problems, like asthma, diabetes or high blood pressure. And they get less preventive care and fewer screening tests, such as Pap smears, mammograms or prostate exams. The result is poorer health, more days missed from work and school and poorer quality of life.

What can we do to help these working families and individuals get coverage? We’ve tried reforming the insurance market. But that didn’t make coverage affordable. The only way to make health insurance affordable is to provide financial help, which is what people with job-based insurance get from their employers and the government. If we aren’t going to require employers to pay for health benefits, then government will have to help.

The good news is that federal funds are available to pay $1 to $2 of every $3 California spends to help provide children and many adults with affordable coverage. But California is using only a fraction of the federal funds that are available, leaving the remainder to be reallocated to other states in a couple of years. The new governor and the Legislature could take the following steps:

* Gov. Gray Davis needs to fix and expand California’s health insurance programs for children. State officials burdened parents with a 28-page application for Medi-Cal and Healthy Families, the new children’s health insurance program. Georgia and some other states use a one-page application. California also could extend eligibility automatically to children who qualify for other means-tested programs, such as school lunch programs or food stamps. California conservatively set eligibility for Healthy Families at up to 200% of the poverty level, about $27,000 for a family of three. The state should increase eligibility up to 300% of poverty, as some other states have, a change that would make insurance affordable for more than 80% of uninsured children and draw in $2 in federal funds for every $1 California spends.

Our elected leaders should push Washington to reassure immigrant parents that they will not be classified as “public charges”--and possibly denied citizenship--if they enroll their eligible child in Medi-Cal or Healthy Families. About half of eligible children, almost all of whom are citizens, have at least one noncitizen parent and many of these children are not enrolling.

* California should expand these programs to uninsured adults. The state can open both Medi-Cal and Healthy Families to parents of eligible children, and even to other uninsured adults who could pay a sliding-scale premium. Some options could help families enroll in their employers’ health plan.

* California should take health care out of welfare. Parents’ stigmatizing experiences with welfare offices discourage many from enrolling their children in Medi-Cal or Healthy Families. We should not make working families grovel at the welfare office to obtain health care.

* California should integrate its half-dozen fragmented health insurance programs into a seamless system. This fragmentation, duplicating eligibility and program administration, wastes money on bureaucracy that could be paying for coverage, and it creates barriers for people who need coverage. Each day that California fails to act, more than 1,500 residents find themselves uninsured, denied access to essential medical and preventive care. California has the authority to fix the problems that create barriers in existing programs, and it has unused federal funds that could help expand affordable coverage.