San Jose May Insure Health of All of Its Children

Here in the Silicon Valley, where e-commerce spits out high-tech millionaires overnight, this booming community is poised to become the first U.S. city to offer comprehensive health coverage for every child.

San Jose may soon provide coverage for the 37,000 children without health insurance by tapping into a bounty of tobacco lawsuit settlements.

“This is the center of the new economy, a valley that is witnessing the greatest expansion of wealth in history,” said Susan Price of People Acting in Community Together, a church coalition pushing the plan. “But many are being left behind.”

The push for comprehensive care, spurred by organized labor and local churches, would provide an estimated $6 million a year to augment existing government programs for children of poor and working families. Promoters hope to enroll more people in established programs and also help working families ineligible for government aid pay for insurance premiums to a designated provider.

A majority of the San Jose City Council has expressed support for the health plan, which is up for a vote June 12. The Santa Clara County Board of Supervisors also is weighing expanded coverage.

That’s all welcome news to Leticia Lopez, a mother of four who works as a janitor at a downtown computer firm. She also moonlights as a house cleaner.

But she can’t afford insurance for her family. When sickness hits, the single mom turns to simple medicine: Tylenol and hope.

“We’re not the only ones,” Lopez said. “Everyone around here lives day to day.”

California has the 10th-worst rate of uninsured children in the nation. In San Jose, one out of every seven youngsters is without health insurance. An additional 30,000 children in surrounding Santa Clara County don’t have insurance.

San Jose Mayor Ron Gonzales has asked whether the city should be getting into health care issues normally handled by the county.

But six of the city’s 10 council members have expressed support. Councilwoman Margie Matthew called the health care problem a “moral crisis.”

E. Richard Brown, director of the UCLA Center for Health Policy Research, applauded the spirit of the proposal, but said the focus should be on improving existing programs. He said many children drop out of Medi-Cal, which provides health care for the neediest families, because their parents fail to sign up every three months as required.

California launched its Healthy Families program in 1998 to provide more widespread medical care to children statewide.

But such programs miss many working families: gardeners, restaurant workers, house cleaners, nannies and security guards.

Boosters of the San Jose effort say the stakes are high. Without a pipeline for medical care, children are more likely to fall ill as babies. They’re less likely to be immunized as toddlers. They don’t get treated for routine illnesses that can turn into serious problems.

Undiagnosed conditions--such as chronic fatigue and poor eyesight--can hurt school performance. A study at one San Jose high school found that half the children who couldn’t read had undiagnosed medical problems.

“That’s a prognosis for a difficult life,” said Bob Brownstein, policy director at Working Partnerships USA, a San Jose-based research group pushing the plan.

State and federal programs provide insurance for many children, but even eligible families don’t always apply. Though the enrollment process has been streamlined, some parents chafe at the bureaucracy. Others work for cash under the table and don’t have the pay stubs and other documents needed to qualify. Immigrants can be wary or too proud to participate.

Peter Long sees it every day. As head of the nonprofit Indian Health Center near downtown San Jose, Long puzzles over why many families don’t sign up.

“With Medi-Cal there’s this huge stigma,” he said. “They’re working and they don’t want to be seen as being on welfare. With immigrants, it’s a fear of government.”

The San Jose proposal calls for $1.8 million in the first year to promote existing health programs--Medi-Cal, the state’s Healthy Families effort, a similar program offered by Kaiser--to the working poor.

Brownstein envisions health insurance enrollment days at schools and waves of promoters going through working-class neighborhoods signing up the uninsured. “What’s needed,” he said, “is a big push.”

The nature of the high-tech industry--rapid innovation, shifting product lines, layoffs--has fanned health insurance problems for working families. Many companies survive with a work force of temporary hires who receive few or no benefits.

Many children--nearly 5,000 in San Jose--are ineligible for government health care but their parents don’t have private insurance.

Pascual Chavez, a warehouse worker in east San Jose, is in the gray area between government programs and private insurance. His employer pays for Chavez’s health insurance, but it would cost $300 a month for his wife and children to join. He hasn’t been able to afford it.

So when Chavez’s son was knocked out during a flag football game at school, the emergency room bill mounted to $1,500. The family is still paying for it.

Juan and Soccorro Barreras have struggled for years to pay the medical bills for their oldest, Ibeth, 9. Born in Mexico, the girl has had problems with asthma, chronic ear infections and a faulty heart valve. With Ibeth continually sick, her mother hungers for insurance but can’t find a program that fits.

“I take her to the doctor,” the mother said, “only when she is almost dying.”

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TOBACCO SUIT DEBATED

The Justice Department charges that cigarette firms continue to target youth. A13