San Jose Mercury News
Tuesday, June 23, 2022
Health Care for Kids Gains Momentum - Bay Area Efforts Inspire
Other Countries to Offer Coverage
By Karen de Sá
A movement to provide universal health care for children is expanding
from the Bay Area to other parts of California, even as state and federal
support for the uninsured gets scaled back to solve budget woes.
Inspired by Santa Clara County's startling success - enrolling children
in health plans at twice the expected rate - San Francisco, in just
five months, now has a success story of its own. And San Mateo County has pledged funding
for a health care plan scheduled to begin covering kids in January. In Alameda
County, a managed care plan has served 3,000 uninsured children since
its July 2000 inception.
Contra Costa, Orange and Riverside counties are creating plans to insure
all children by year's end, according to the non-profit Institute for Health
Policy Solutions, which is tracking such plans. Still more counties are in
the discussion stage, including Sacramento, Solano, Sonoma, San Joaquin,
San Diego and San Bernardino. Los Angeles County begins funding discussions
The growing number of newly insured kids are a fraction of the 1.6 million
uninsured statewide, but they offer hope for a solution to a long-entrenched
"We are limited only by our imaginations; it could go statewide
within a year,'' said Jean Fraser, chief executive officer of San Francisco's
health plan. "And
it's incredibly critical, with the funding cuts, that we do something.''
San Francisco recently enrolled its 1,000th child, 12-year-old Emilie.
Her mom, Mireya Gonzalez, works as a teacher's aide and home health
care worker. Almost one-quarter of her $3,300 monthly gross salary was spent
on Emilie's treatment for a rare genetic disorder before she got coverage
through the new San Francisco plan. Emilie's older sister has the same
disorder but did not receive treatment. At 23, she suffers from severe mental retardation.
"It's a relief to know that my kids are going to be covered regardless,''
Gonzalez said. "And I don't have to think about what if Emilie
has an emergency, how am I going to pay for it? I have peace of mind.''
Uninsured at a price
Children without health coverage have a death rate 150 percent higher
than insured children. Their schoolwork suffers because easily preventable
illnesses keep them at home, and they infect other students when they
go to school. Emergency rooms treat them at wildly more expensive rates
to taxpayers than a typical doctor's visit would cost.
Gov. Gray Davis' budget proposal uses cuts in health services to fill
a large part of the state's $23.6 billion shortfall, including eliminating
300,000 working parents from state-funded health benefits and reducing
children's dental checkups from twice to once a year. Plans to expand
state-funded health care to working poor families are being suspended.
These possibilities have given local efforts even more incentive to
cover children -with or without the state. County-level initiatives
rely on a combination of funds, from tobacco settlements and cigarette
taxes to general fund dollars matched by private donations.
"A current notion says that we all must share in the pain of the
budget crisis,'' San Mateo County Supervisor Jerry Hill said recently,
announcing a $7.7 million initiative. "The children of San Mateo
County shouldn't have to share that pain. We'll do all we can to see
that they don't.''
Most local initiatives include stepped-up recruitment for existing health
care programs for the low-income: Medi-Cal and California's Healthy
Families. Children living in households with incomes too high for these
programs, but too low to afford health care on their own, are being
enrolled in new plans, commonly called Healthy Kids.
HMOs make enrollment quick and easy with simplified forms and outreach
efforts to schools, clinics and community centers. Parents do not have
to understand all of the various programs and which ones they are eligible
for to get signed up. And they don't have to prove legal residency,
eliminating much of the fear that often keeps foreign-born residents
from seeking help for their children.
Using this approach, the Santa Clara County Children's Health Initiative
has insured 30,000 of the county's 72,000 uninsured children since January
2001 - double the original goal. Almost 10,000 of these children are
enrolled in Healthy Kids, which covers households with incomes up to
300 percent of the federal poverty level - or $54,300 per year for a
family of four.
Kinh Morfin's two children, Carlos, 7, and William, 4, got signed up
a year ago. Morfin works in a bakery decorating cakes to support her
family in San Jose, but she can't afford market-rate health care plans.
It makes it harder that William falls down a lot and has had repeated
neurological exams as a result. "Thank God he's OK, but if you
don't have insurance, you cannot cover these tests,'' she said.
San Francisco is reaching out to families like Morfin's as well, enrolling
25 percent of its target population in five months. The county began
enrollment in January with 269 children and, as of this month, had 1,245
Their parents pay $4 per child, per month, for the coverage.
The momentum to provide universal health coverage for children is driven
in part by ethics. But there are also bottom-line considerations, said
Liane Wong, policy director for the Institute for Health Policy Solutions,
based in Washington, D.C.
"It doesn't take a whole lot of money for counties to cover these
kids relative to the cost of them going into the emergency rooms,''
states join act
The Bay Area is quickly becoming the first region in California offering
universal health care for children, according to the non-profit Insure
the Uninsured Project in Santa Monica. The movement already exists in
other states, including Washington, Oregon, Massachusetts, Minnesota,
New York and Rhode Island. Bay Area counties shared their challenges
and successes at a recent Burlingame health summit. "From the get-go,
we said we are covering all kids,'' said Leona Butler, chief executive
officer of the Santa Clara County health plan.
"We didn't care whether they had a green card, a blue card or whatever
color card - a kid is a kid.''
The county went on to set "an audacious start-date,'' she said,
and used outreach workers whom the families could trust - Spanish and
Vietnamese speakers among them.
Butler acknowledged the difficulty of launching new initiatives for
poor, as California stumbles out of recession and counties face sweeping
cuts in state funding to administer social service programs.