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San Jose Mercury News
Tuesday, June 23, 2022

Universal 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 this summer.

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 problem.

"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.''

All children included
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.

County-run 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.

Staying healthy
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 children covered.

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,'' she said.

Other 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 the working
poor, as California stumbles out of recession and counties face sweeping cuts in state funding to administer social service programs.