Critics Decry Medical Cuts

Outlining his budget priorities this week, Gov. Gray Davis promised to protect health care for poor children even as he tried to overcome a $23.6-billion deficit.

But both directly and indirectly, the governor’s spending plan would hurt children’s medical care, advocates say.

These critics say Davis’ proposals to cut outreach funds would mean families remain unaware of their eligibility for public health insurance programs. Decreasing Medi-Cal payments to physicians would mean fewer doctors participating in the program. And, they say, experience has shown that scaling back parents’ eligibility for coverage would mean that fewer eligible children would be signed up as well.

“We can’t put kids’ health on hold for a year while we figure out how to better balance our budget,” said Amy Dominguez-Arms, vice president of Children Now, an advocacy group in Oakland.

The governor’s top priority was to shield public education from the knife, but children’s advocates said a child’s ability to learn depends on more than classroom and teacher spending.

“Cuts that affect families’ access to health affect children’s readiness for school,” Dominguez-Arms said.

State officials argued that the governor did his best to protect children’s health programs. His budget does not cut any children out of the government-subsidized Medi-Cal or Healthy Families programs, nor does it impose additional paperwork requirements on families to keep children enrolled.

In fact, officials estimated, enrollment in the Healthy Families program for children of the working poor is expected to jump from 559,000 this year to 624,000 next year. Healthy Families covers children whose families earn too much to qualify for Medi-Cal but not enough to afford private health insurance.

“The governor’s commitment to kids remains, and it’s unparalleled, not only in health insurance but across the board,” said Glen Rosselli, undersecretary for Health and Human Services.

Still, the proposed budget cuts would stall outreach efforts.

For instance, Davis has postponed for three years an initiative that would have allowed schools to automatically enroll children in Medi-Cal if they are eligible for the free and reduced lunch program.

The governor has proposed eliminating $18.6 million for other outreach campaigns by schools and nonprofit groups. That comes just four months after Davis stopped payment on $20.7 million for media campaigns to enroll kids.

“He’s just dismantling this infrastructure that we’ve been trying to build in this state for the past 2 1/2 years,” said Lark Galloway-Gilliam, executive director of Community Health Councils of Los Angeles. “What is wrong with this man?”

Children may also be hurt by the governor’s proposal to reduce reimbursements to physicians and other health-care providers, health-care advocates say.

For example, payments to California Children’s Services would drop by 49%. That agency helps offset the costs of treatment for patients under age 21 with complex conditions that are either life-threatening or debilitating.

“Their care literally depends on these programs,” said Dr. Stuart E. Siegel, a member of the Children’s Specialty Care Coalition, a patient advocacy group.

Perhaps the greatest impacts of the budget cuts on children’s health, however, would be indirect. Research has shown that when adults have insurance, their children are more likely to have insurance.

“Children follow their parents to the doctor’s office,” said Yolanda Vera, senior health policy attorney at Neighborhood Legal Services in Los Angeles. If parents have to pay more for private insurance, “it’ll have a back-door effect on kids.”

On Tuesday, the governor proposed increasing the income requirements for two-parent families to enroll in Medi-Cal. Families would not be allowed to enroll unless they earn less than 67% of the federal poverty level. All families earning less than the poverty level are now eligible.

The budget also would reinstate procedures in which adults need to fill out forms every quarter, instead of annually, to remain enrolled in Medi-Cal.

“If you start imposing more requirements for going down and reenrolling, you will create greater confusion in the health-care system,” said Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured. “The more confused people become, the less likely they are to sign up themselves or their kids.”

All told, the state expects the cuts to lower Medi-Cal rolls by 490,600, or 7.5%, below the governor’s previous predictions.

Politically, the health cuts could put the governor in a difficult position. Davis has acknowledged the link between the insurance status of adults and children’s access to care.

He first proposed expanding the Healthy Families program to cover 300,000 working parents in 2000, suggesting that children would be enrolled when parents were enrolled. He later delayed the expansion for fiscal reasons, then supported it, and now has delayed it again.

Though his critics accuse Davis of a lack of commitment to children and the poor, political analyst Sherry Bebitch Jeffe said Davis was savvy in his budget choices.

“I don’t think he’s given up on health care, per se, but I do think he has targeted programs where he perceives that there is less political risk in cutting,” said Jeffe, a senior scholar in the School of Policy, Planning and Development at USC.

“It’s the people who don’t tend to vote as opposed to types of health-care programs that might impact more middle-class voters.”