Keeping Kids Healthy, Without the Politics PDF Print E-mail
By Zach Friend, Special to Santa Cruz Wire
SANTA CRUZ (November 2009) - The recent funding crisis facing the state Healthy Families program, which provides much needed health insurance to California’s children, highlights an oft-ignored reality; that our failed state budgetary process and ideological entrenchments have a real-world effect on the health of actual children.
Year after year, funding for Healthy Families and other State Children's Health Insurance Programs (SCHIPs), have been in flux.  Since its creation in Congress in 1997, SCHIP has faced budgetary stalemates that put the health of thousands of children directly in the hands of a broken process.
In 2007, after deadlocking over legislation to reauthorize and expand the program, Congress and the President agreed to provide a lifeline to SCHIP until March 2009. Funding has since been continued until 2013.
A BARGAINING CHIP
Within California, the track record has not been much better. Enrollment freezes, caps and cuts have been used as political bargaining tools for the last five years. Recently Governor Arnold Schwarzenegger signed AB 1422, designed to keep more than 600,000 of California’s children covered under Healthy Families. This was a reversal from previous stances by the governor, including a standard veto threat to all bills unless lawmakers meet his demands to resolve energy, prison and water issues.
Certainly, prisons, power and water are important issues. But we urgently need to find a way to depoliticize health care access for our children.
Just what is Healthy Families and why does it matter? Healthy Families provides government-subsidized health coverage to low-income children in families that earn too much income to be eligible for Medi-Cal.
THOUSANDS OF SANTA CRUZ KIDS ENROLLED
In Santa Cruz County, more than 5,000 children are covered. The program requires cost-sharing ($4-$17 per child) and a small co-payment for doctor visits. In exchange, children receive medical care, dental care, eye care, prescription medications, immunizations, mental health care and more.
It has been well documented that children without health insurance coverage get less health care, have greater barriers to access and poorer overall health than children with any type of health insurance.
In Santa Cruz County over 9,000 children live below the poverty level (about 15 percent) and approximately 1,400 have no health insurance coverage at all.
Studies have shown that uninsured children are more than three times less likely to have seen a dentist and two times less likely to be in good health compared to children with Healthy Families.
A VICIOUS CYCLE
Beyond the individual suffering of children, there are broader economic and social costs to not insuring a child. Lack of coverage, and resulting poor health, can create a cyclical problem, lowering a child’s educational attainment and earnings later in life. Parents caring for children in poor health are more likely to be out of the labor force and less likely To build tenure at jobs that can lead to higher wages – or a job that carries health insurance.
Santa Cruz County has worked to eliminate this health and achievement gap through innovative funding measures.
The Health Improvement Partnership has created a local Healthy Kids program to enroll children in Medi-Cal, Healthy Families or their own program. Healthy Kids, which receives funding from public and private sources, provides coverage when families do not qualify for Healthy Families or Medi-Cal because of household earnings or other reasons. 
SANTA CRUZ SUCCESS MIXED
This public-private partnership has slashed the numbers of uninsured children in Santa Cruz to approximately 2 percent, compared to the state rate of over 7.5 percent.
While a 2008 Santa Cruz County Public Health Report Card shows that local children are faring better than some of their state counterparts, it did show unfortunate trends of an increase in obesity and tobacco usage. In addition, the report showed that children in Santa Cruz County were more likely to be without dental coverage (nearly 27 percent are without coverage) than the statewide average (21 percent).
California Assembly bill, AB1422, eliminates the programmatic cuts to Healthy Families but mostly relies on budgetary shell games. For example, the bill accounts for an $81.4 million donation from California’s First 5 Commission, imposes a 2.35 percent tax on insurers that administer benefits and increases cost sharing (through rising co-payments and premiums) from parents. 
SOMETHING FOR EVERYONE TO LOVE/HATE
Even with these elements, it appears to have received bipartisan support because it provided A little something for multiple interest groups.
According to Health Access California, health plans did not did not object to paying the new tax as long as the state drew down federal funding that went back to them and the new 2.35 percent tax is lower than the 5.5 percent fee that health plans contracted by the state to manage Medi-Cal and Healthy Families coverage currently pay.  
The cost-sharing element, while an added burden upon financially-strapped communities, is an important feature toward maintaining self-sustainability of the program.
Even though Healthy Families received a much-needed reprieve, the question remains about how to protect our children in the future.
FUTURE FUNDING
Moving forward, legislators should look for ways to insulate children’s health outcomes from an unquestionably broken state and federal budgetary process. While federal reauthorizations provide some insulation, year-to-year state budget issues put funding into flux. 
State and federal legislators need to work to eliminate this funding insecurity. Parents and children are unsure on any given year whether affordable health care will be available. Some possible ways to address this could be tied to federal health care reform. 
Making the program more self-sustainable, possibly through large-scale rate negotiations, is a potential (but difficult) avenue.  While making the program more entitlement-based would be too costly and has legitimate macroeconomic consequences, the general recognition that children’s health care is more important than discretionary funding is an important philosophical step.
Looking into trust funds, set-asides and self-funding structures could help take it out of the whims of the budget process.
Health epidemics, such as the H1N1 virus moving rampantly through our nation’s schools, cannot be effectively slowed without access to care and health insurance.
Children should not be placed on a long-term trajectory toward lower educational attainment, poorer health outcomes and depressed wages because of something as arbitrary as a state and federal budget process.

 Zach Friend is a Santa Cruz Resident and Chair of the Santa Cruz County Democratic Party

 

 

 

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