A Healthy Outlook for Children’s Medical Care

Every youngster in California would qualify for health insurance if a bevy of legislative proposals and local efforts goes forward, creating what advocates say is the most promising moment in years for children’s healthcare.

In his revised budget, Gov. Arnold Schwarzenegger has proposed spending $58 million, which would draw nearly as much in federal matching funds, to expand children’s health coverage.

And a tobacco tax initiative expected to qualify for the November ballot would offer long-term funding for universal children’s coverage.

These and other proposals would cumulatively provide insurance to the nearly 800,000 uninsured youngsters in the state under age 18, including those who are undocumented.

“This is the strongest push that I’ve seen, period,” said Wendy Lazarus, a longtime children’s healthcare advocate who founded the Children’s Partnership, a sponsor of the tobacco initiative. “This is a once-in-a-generation opportunity to take care of the health insurance problem for kids.”

Some parents are equally enthusiastic, saying universal coverage would provide welcome relief.

“My husband would not have to kill himself working so much,” said Los Angeles mother Fabiola Lopez, referring to the out-of-pocket fees she and her husband pay to get medical care for their undocumented children.

Universal coverage for children has broad popular support. A United Way poll released last month found 83% of California voters in favor of a state proposal to “ensure every child has health insurance.” It ranked public support for children’s coverage above increasing funding for K-12 education -- traditionally one of the most popular issues with voters, said pollster Ben Tulchin, who conducted the survey.

Currently, a jigsaw puzzle of insurance programs covers slightly more than 9 million children, more than 90% of the youngsters in the state, according to 2003 data from the California Health Interview Survey.

Medi-Cal, the state’s version of Medicaid, provides free insurance to children of the poor. The state’s Healthy Families program covers children mostly from working families that cannot afford private insurance. Neither covers undocumented children generally, though Medi-Cal covers emergency services.

In an increasing number of counties, local programs, funded by public and private money, cover children who don’t qualify for Medi-Cal or Healthy Families. Undocumented children who need nonemergency care, for instance, can be covered under these plans.

Undocumented children constitute at least 12% of uninsured children in California, said E. Richard Brown, director of the UCLA Center for Health Policy Research.

Of the total number of uninsured children, about half are eligible for Medi-Cal or Healthy Families but are not enrolled; experts say the complexity of applying or determining eligibility deters many parents. The rest are ineligible for either program and may not have access to local programs.

Proposals for bridging these gaps in coverage include:

* The tobacco tax initiative, which would raise the tax per cigarette pack by $2.60 to $3.47 to expand Healthy Families. Children in families earning up to almost $60,000 a year for a family of four would be eligible for coverage; the current cutoff is about $50,000 for a family of four. Undocumented children in families meeting the income requirement would also qualify.

* A Senate bill that calls for a statewide insurance program, California Healthy Kids, under which Medi-Cal and Healthy Families would operate. Application procedures for families would be simplified to help children get and remain enrolled.

* A $40-million Assembly proposal that would boost funding for local programs. Eighteen counties, including Los Angeles, San Francisco and Riverside, have founded such programs since 2001, and other counties are planning to.

Healthcare providers and children’s advocates say coverage during children’s formative years is critical. Preventive care is less expensive than treating chronic illness, they say, and good health can improve children’s performance in school.

Children are also relatively inexpensive to insure, costing about $1,100 per year compared with roughly $4,000 or $5,000 for an adult, according to experts.

Peter Long, director of research and planning for the California Endowment, a healthcare foundation, said California is benefiting from growing interest in locally funded programs as well as from the pioneering efforts of Illinois, which passed legislation last fall guaranteeing universal children’s health coverage.

“What’s stopped a lot of healthcare reform discussions is they’re academic; people inevitably ask, ‘Can it work in practice? What does it mean in real life?’ ” Long said. “These [local] children’s health initiatives show that, on the ground, it works.”

Jim Keddy, director of the faith-based group PICO California, which advocates for increased access to healthcare, said the momentum toward universal coverage was growing. Many children already are covered, he said, and the state budget is less tight than in recent years.

“We consistently were hearing, ‘Well, that’s a terrific idea, but we can’t afford it,’ ” Keddy said. With this year’s budget windfall, “Now, people are saying, ‘We have some flexibility. How should we invest these dollars?’ ”

But in Sacramento, some legislators questioned the wisdom of spending taxpayer money on insuring illegal immigrants.

“If they’re here illegally, they’re not the financial responsibility of the state of California,” said state Sen. Dave Cox (R-Fair Oaks), who sits on the Senate’s Health Committee. “Providing healthcare for everyone is just a financial burden that this state can’t sustain.”

Assembly Speaker Fabian Nunez (D-Los Angeles) disagreed, saying universal children’s coverage would be a wise investment in California’s future.

“If we want to have a well-trained, well-educated workforce to take on the challenges of the 21st century,” he said, “their health is of utmost importance.”