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Dwana Simone Bain

County to start Healthy Kids next month

BURLINGAME -- Housing or health insurance? No parent will have to make that choice, if the Children's Health Initiative's efforts to insure all children in San Mateo County are successful. In January, the county will add the Healthy Kids program, a $7.7 million endeavor to insure the youth of San Mateo County. However, there are those who believe the Healthy Kids program is too generous, providing health coverage for children whose parents are not financially needy. Much of that opposition comes from the Peninsula Health Care District and its constituents.

San Mateo County Health Services Director Margaret Taylor said the biggest opposition from the project came from the district, which hedged for three months over whether to offer the program funding before finally committing to $750,000 next year.

One of the biggest objections to the funding came from board Chair Vince Muzzi, who in October wrote Taylor a letter, highlighting his problems with the program. "My concern is, as it's now structured, CHI's plan will cause both employees and employers to step back from current coverage levels or cause new employers or employers planning to offer coverage not to cover children at all."

The goal of the Children's Health Initiative is to insure 14,600 now-uninsured children by maximizing enrollment in available programs, including state-run Medi-Cal, Healthy Families and the new county program, Healthy Kids.

Healthy Kids would provide pediatric primary care, drug coverage, dental care, immunizations, psychiatric care, vision and preventative care.
Enrollment fees would range from $4 per member each month for the lower income families in the program, to $20 per member per month for those on the upper end of the income limits, which is 400 percent of the Federal Poverty Level, about $61,500 for a parent and two young children.

But with the program's low cost to employees, paired with the constantly increasing cost to employers who provide health care, Muzzi believes the program could help kill employer-sponsored insurance at many businesses. "It may become especially attractive to employers to offer employees a cafeteria plan that will allow an employee to use untaxed wages to pay for their subsidized county coverage of their minor children where both the employer and the employee will be allowed to effectively, 'save money'" he wrote to Taylor. "It's a win for the employer and a win for the employee but it's a burden on the taxpayer," Muzzi said.

Taylor does not believe such a shift will occur. Healthy Families -- which offers similar benefits to Healthy Kids -- has existed for years and has not seen people abandoning employers' insurance.

"Most people expect to get benefits from their job," she said, adding that if such benefits are not offered, "It doesn't make the job that attractive." And lowering the ceiling for providing health coverage -- as Muzzi suggested -- would not achieve the initiative's goal of universal coverage for children, according to Taylor.

San Mateo County's upper income limit for Healthy Kids is higher than that in other Bay Area counties, Taylor acknowledged. In those counties, the limit to qualify is 300 percent of the Federal Poverty Level.

Taylor attributes the higher allowable income in San Mateo County to the comparatively high cost of living and childcare in the county.

Approximately 80 percent of the uninsured children in the county come from families with annual incomes of less than $45,000 per year, Taylor said. Many of those children come from families who are undocumented.

That is one significant way that Healthy Kids differs from the state-run insurance programs. It does not require proof of citizenship or legal alien status. "Legal status isn't an issue," Taylor said.

While some might object to insuring children who are not legally in the country, Taylor and other health officials argue that from a public health standpoint, it is important to provide all children with immunizations and preventative care. Uninsured children who go without care are more prone to pass on communicable diseases to insured children and are also more likely to use the emergency room, increasing overall health care costs. "It's better that they come in for regular care than to use an emergency room where they have to get care," Taylor said. Each county that has implemented a Healthy Kids program has compiled funding from different sources.

San Mateo County's program is particularly patchworked, funded through several different sources, with each source committing to a different length of time. The First Five Commission made a 10-year commitment.

San Mateo County supervisors committed to five years, as did Sequoia Healthcare District.

Two foundations committed to grants of two years and three years.
Peninsula Health Care District committed only to one year -- and that was with significant debate.

Muzzi voted against the district's $750,000 grant to the program. "I thought that $750,000 was more than we should be putting into a program at this point," Muzzi said.

Several people who live in the health care district pleaded with the board not to commit such a large percentage of its income to the program, arguing instead that district funds should go elsewhere.

"It's a precipitous move to vote on this tonight," resident Ken Castle told the board before its Nov. 21 vote. "It's a precipitous project." Burlingame resident Terry Huebner was concerned that money used to fund Healthy Kids would take away from other deserving programs.

"There were other people who wanted grants. I think it was way too much money to give to one organization," Huebner said. As for Muzzi's statements, "I think a lot of his concerns, we all shared," she added.

Taylor believes those concerns are overblown. Based on the experience of county outreach workers who have enrolled individuals in health care programs, 90 to 95 percent of parents whose children are eligible for Healthy Kids work in jobs that do not offer health insurance.

The health initiative will require that children need to have been uninsured for six months to qualify for Healthy Kids. The county will randomly audit applicants to determine whether an adult has available coverage for dependents, and whether the worker contribution to cover the children is affordable.

Nevertheless, Taylor will watch the program carefully. "We'll be very mindful of the comments people have made about our project," she said. Meanwhile, Taylor is eager to get the project up and running. "This is stupid to have so many kids uninsured in the county like this," she said. "I just want to get this thing ready to start in January."

The county will begin collecting applications for Healthy Kids on Jan 2.