Pitching health care for all kids

By MICHELLE GUIDO

June 13, 2000 Web posted at: 5:15 PM EDT (2115 GMT)

SAN JOSE, California (San Jose Mercury News) -- At first glance, the proposal to make San Jose the first city in the nation to guarantee health insurance for all children sounds like an impossible ideal.

But arranging health insurance for the 37,000 kids who aren't covered could possibly be done for $6 million a year, just a fraction of the $2.2 billion it costs to run city and county operations.

The unprecedented plan would be the first real test of whether universal health care for children could work. It's something no city, state or federal agency has tried. And the boldness and novelty of the proposal, which would take advantage of the 20-year windfall from the national tobacco settlement, has already drawn national attention.

The San Jose City Council is scheduled to take up the issue at a budget hearing tonight.

``My gut reaction to the whole thing is this is a really good idea, and we ought to try it,'' said Alain Enthoven, professor of management in the graduate school of business at Stanford University and one of the nation's foremost authorities on health insurance. ``I have worked for many years on the issue of universal health insurance, and I am somewhat baffled as to why it doesn't seem to have more political support.''

Community groups and educators are urging San Jose and Santa Clara County officials to set up a fund to get uninsured children who are eligible signed up for state and federal insurance programs and to help pay the premiums. In the cases where they don't qualify for subsidized care because their parents earn too much, the fund would pay for private insurance policies.

The plan's most outspoken opponent is San Jose Mayor Ron Gonzales, who argues that health care should not be a city responsibility. Gonzales wants to spend the city's tobacco money on education, anti-smoking initiatives and programs for the elderly.

Carole Nichols, a nurse in the Moreland School District, uses a recent schoolyard injury to make a case for the plan. She said an uninsured student recently stumbled on the playground and cut her head, but her mother was afraid to take her to the doctor. Nichols talked her into taking her daughter to the emergency room. She needed 11 stitches; the bill was $519.

That's exactly the type of situation that would be remedied under the proposal's major thrust: to sign up all eligible kids for Medi-Cal and Healthy Families, the state's main subsidized health programs.

``This woman is a legal resident who is eligible for Healthy Families,'' Nichols said. ``And it would only cost her $18 a month for her three children -- but even that is prohibitive. So if there were a fund set up to help pay premiums, that would be a huge relief to so many parents.''

Working Partnerships, an affiliate of the South Bay AFL-CIO Labor Council, and the activist group People Acting in Community Together are pushing the proposal and in recent weeks have stepped up their campaign to garner support.

``Ten years ago this would have been impossible, but with the expansion of Medi-Cal and Healthy Families benefits, there has been so much progress that there's only a little gap left,'' said PACT's Kevin Malone. ``We spotted that and said, `Whoa, look at this, we're getting pretty close to covering all kids, and it wouldn't cost that much more to fill the gap.' Tobacco money seemed like a good opportunity to create a pilot project here that shows to the state and the country that it's not that far away.''

Uninsured children can't go to the doctor for check-ups and shots unless their parents can pay for the full cost of those visits. And many parents with uninsured kids avoid taking them in for care because they fear the costs involved.

Children with health insurance -- whose parents regularly take them to the doctor for preventative care -- are less likely to suffer from avoidable chronic childhood illnesses and become a drain on the county's hospital system by coming in only when they need emergency care. And they are more likely to be properly immunized against disease and succeed in school -- that's why some educators are lending support to the proposal.

Santa Clara County supervisors Jim Beall and Blanca Alvarado have asked the county to set aside $3 million of its tobacco money in the next fiscal year for the program. The two community groups pushing the plan have asked San Jose to contribute at least $2 million.

Last week, six of the 11 city council members said they would support the plan. But one of them, Councilwoman Pat Dando, has since backed away.

``I'm not convinced we know what kind of health care program San Jose's children really need,'' she said.

The county supervisors, who control the county's public health programs, appear more inclined to support the proposal.

``Whether the city does its part or not, we're going to do our part,'' Alvarado said. ``If we have to go it alone, we'll go it alone. We are not going to stop in our tracks because the city is not willing to do it.''

Alvarado is baffled at the city council's reluctance to get behind the proposal. ``It would seem to me they would jump at the opportunity to truly be innovative, to have leadership, be aggressive,'' she said. ``If San Jose doesn't join in this effort, they'll have to be held accountable.''

Bob Brownstein, policy director for Working Partnerships who was budget and policy director for former mayor Susan Hammer, said this is a unique opportunity to accomplish something unprecedented -- and sustain it. For the next 20 years, both the city and county will receive money from the tobacco settlement. In the coming fiscal year, the city will receive $10 million and the county $18.5 million.

County officials hope that if the plan succeeds in San Jose, the other 14 cities in the county might be inspired to do the same thing.

``It's not an unreasonable goal, if they say thousands are eligible for state programs, then the big problem is the low number of people who take advantage of what they're entitled to,'' said Stanford's Enthoven. ``A big community effort to get everybody who's eligible for these programs to get in there and signed up is a good idea.''

The most important, and first step, is outreach. Of the 37,000 uninsured children in San Jose, Working Partnerships estimates that nearly three-quarters would qualify for Medi-Cal or Healthy Families. Those programs are available to families that earn as much as 250 percent above the federal poverty levels. For a family of four, that would mean an annual income of about $42,600.

The second step would use part of the money to help pay premiums for families who can't afford them. Under Medi-Cal, there are no premiums or co-payments, but with Healthy Families, a modest premium of between $4 to $9 per child per month is required. Even that small amount can be prohibitive for a working poor family with four children.

Lastly, the kids who do not qualify for state programs would be signed up for private insurance, either through Kaiser Permanente or other health plans. Working Partnerships estimates that private insurance premiums could average about $75 per month for each uninsured child. That could cost $4 million a year.

The county already has put millions into its own existing outreach program, and just last month, the board of supervisors added $1.9 million to its Valley Community Outreach Services to more than triple the staff members, from 10 to 30.

Three county outreach workers staffed a drive at Anderson Village School last week, and more than 70 children were signed up.

Marilyn Cornier, program manager of Valley Community Outreach Services, said recent changes in the state's Medi-Cal and Healthy Families guidelines have increased the pool of eligible children and families. And the application for those programs -- which used to run 27 pages -- was pared down last year to a simple four-page form.

There are a number of reasons why those eligible for the programs don't sign up. First, many aren't aware that there is health insurance coverage available at low- or no-cost -- even for undocumented immigrant children. Recent immigrants from some cultures in the diverse South Bay equate Medi-Cal with welfare and are reluctant to sign up because they fear it can affect their permanent resident status.

Teresa Mo, health project manager for Asian Americans for Community Involvement, said she and two other AACI staff members already work to get their clients signed up for health insurance. A big part of their job, Mo said, is to reassure recent immigrants that applying for medical insurance won't jeopardize their chance to become permanent residents.

``To Asian immigrants, the outreach is most important because many of them will take pride in paying their own premiums if they're affordable,'' Mo said. ``Sometimes people tell me, `I'd rather pay a few dollars for Healthy Families, rather than get Medi-Cal for free.'''

Still others who aren't covered know they won't be turned away from a county-run hospital or clinic if they show up. Of course, they will be billed for services, but when they can't pay, the county is forced to absorb those expenses.

``Here's an excellent opportunity to provide health access and health education and to begin to really be a part of preventative and ongoing health care for children that otherwise wouldn't have taken place,'' said Felix Alvarez of the Santa Clara Family Health Plan, a health maintenance organization that provides health care for Medi-Cal and Healthy Families recipients. He works with Alum Rock School District on their outreach program, which in part has targeted children who are also eligible for subsidized school lunches. Alum Rock Superintendent Santiago Wood said 7,000 of the 16,000 children in his district do not have health insurance.

Alvarez said the proposed plan would be enormously helpful to those families -- undocumented immigrants among them -- that don't qualify for subsidized insurance programs.

``It's a very, very progressive plan,'' Alvarez said. ``And it will be a milestone that will probably set an example for other cities and counties in the state.''

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