Good News, Bad News for Children

It is a convention of the “gotcha” media that if there’s a problem, the politicians not only won’t fix it, but will make a bigger mess. This is only half-true. Actually, the government’s success rate is about the same as for any cross-section of evolving humans. Case in point: California’s good-news-bad-news evolution on the matter of health insurance for kids.

Good news first. In the past several months--though the media haven’t much bothered to note its progress--the push to insure low-income children has quietly and gradually turned into one of the more reassuring success stories in the state. The battle’s not won yet, but if momentum continues as expected through next week in Sacramento, most of the glitches that had California giving to its have-nots with one hand while taking away with the other will soon be history.

Particularly noteworthy has been the evolution of Healthy Families, California’s federally matched program for insuring the children of the working poor. When Healthy Families last appeared in this space a year and a half ago, it was all but on life support. No other state in America, it seemed, had done such an effective job of discouraging struggling workers from getting their sick kids to doctors. The application alone was 28 mind-bending pages long.

There was serious confusion about whether immigrant parents might end up deported for trying to insure their U.S.-born children--confusion that then-Gov. Pete Wilson was in no hurry to clarify. Outreach was so spotty that vast swaths of the state didn’t know about the program at all.

By the time Wilson left office, six months into the program, roughly five eligible kids out of six were still unenrolled. But, as noted, not even government is 100% incompetent. After Gov. Gray Davis took over, bit by bit, Healthy Families enrollment began climbing. If the public didn’t hear about it, it may have been because there was no single, dramatic solution--just a lot of small, obvious improvements: clarification on the immigration questions, more money for advertising and outreach, a new, whacked-back, four-page application form.

“It’s just been phenomenal,” Peter Anderson, deputy director of the state’s Managed Risk Medical Insurance Board, which oversees Healthy Families, remarked late last week. By May, even with new, much-broadened eligibility standards, 45% of the 639,000 kids who qualify were enrolled. Moreover, the state budget bound this month for the governor’s desk has, with Davis’ blessing, millions more for Healthy Families, in part to ensure that the state doesn’t lose its federal matching funds by failing to sign up enough children. There is money to augment advertising and cut back on paper pushing, and bold streamlining, not just for Healthy Families, but also for needier families on Medi-Cal.

Anderson estimates that, with what’s in the pipeline, he should have almost every eligible kid in California enrolled in one program or the other by the end of next year. Which brings us to the bad news: The legislation that tidied one mess now threatens to resurrect another. Over the weekend, laws keeping HMOs at arm’s length from the state’s lucrative Medi-Cal and Healthy Families market were--at the behest of the governor--eased.

Here’s why this matters. Under the old rules, if, say, you were to go to a booth at a health fair with a question about a Healthy Families or Medi-Cal application, it could only be answered by a neutral party (generally a social worker from some community group). HMOs--be they Blue Cross or some nonprofit plan run by your county--have had to plead conflict of interest lest they be tempted to pitch their plan to you.

Why? Because the last time HMOs were allowed to get within marketing distance of poor people with government subsidies, vast fraud and abuse ensued. Until HMOs were banned from signing up Medi-Cal recipients in 1996, they hounded beneficiaries from clinics to check-cashing outlets to city buses, offering $20 bills and free fried chicken as illegal signing bonuses. People were conned into signing up for plans that disallowed their doctors, that offered no care in their languages, that often didn’t even have offices near their homes. So why let the fox back into the henhouse, risking federal funding? Davis’ people say it’ll speed sign-ups and that fines and spot checks will help HMOs resist temptation. But the risk isn’t necessary now.

This point was made by Baldwin Park Assemblyman Martin Gallegos and the nonprofit Health Consumer Alliance, which noted in one study that this new change is worth up to $4.4 billion to HMOs. Not that they got more than half a hearing. Evolution is slow.

Shawn Hubler’s column appears Mondays and Thursdays. Her e-mail address is shawn.hubler@latimes.com.