Providing healthcare for all kids

San Jose, Calif., may become first to offer universal coverage. Willother cities try it?

Known for its technology innovations, this Silicon Valley city could soon plow some new ground in public policy, too.

Fueled by grass-roots advocacy, broad political appeal, and dollars from the 1998 landmark national tobacco settlement, San Jose could become the first city in the nation to fund health insurance for every child under 18.

The plan, which could gain approval early this week, would patch together a $6 million annual program, starting this year, to fund basic health coverage for all 37,000 children now uninsured in San Jose.

"We're excited about this because it's so important for us that have children," says Sylvia Aliaga, a San Jose mother who is about to lose coverage for her daughter because her husband's assembly job is moving to Mexico.

Others are excited by the idea, too. Indeed, the plan is being watched well beyond the confines of Silicon Valley, a seeming reflection of heightened American concern about health issues.

"The initiative would set a precedent for the rest of the state and the entire nation to follow," says Marian Wright Edelman of the Children's Defense Fund in Washington, who recently endorsed the proposal.

Big bucks from Big Tobacco

Making the plan possible is the 1998 settlement between the tobacco companies and the states. That agreement creates, in effect, a new revenue stream of about $206 billion over the next 25 years. Some 46 states will receive funds and in two of them - California and New York - a handful of cities are also entitled to a direct share of the money.

Given the fact that the tobacco revenue comes on top of already prosperity-fattened state and city budgets, the National Conference of State Legislatures (NCSL) calls the opportunities for new and innovative programs "staggering."

While the first installment of the annual funds went to the states this spring, many legislative bodies are still ironing out how it should be spent.

So far, according to Lee Dixon of the NCSL, who is tracking the states' plans, the majority of dollars is being funneled to healthcare-related programs. Big chunks are going to antismoking campaigns and education projects. States and municipalities have virtually free rein to spend the money as they see fit.

"A number of states are using the dollars to enhance healthcare," says Mr. Dixon. "But San Jose's ambitions are more sweeping than anything else we've seen."

Still, it is not a done deal.

San Jose Mayor Ron Gonzales opposes the plan. And while enough members of the City Council have voiced support to ensure passage, a few changed minds by the time a final vote rolls around on Tuesday would surprise no one.

An ongoing expenditure

A spokesman says the mayor's opposition is based on reluctance to commit the city to an ongoing expenditure in healthcare when that has traditionally been the responsibility of the county. Also, the mayor has other priorities for the tobacco funds: education, antismoking measures, and programs to help seniors.

The proposal would have the city and the county kick in $2 million each annually. Another $1 million would come from the state's 50-cents-per-pack cigarette tax. The remaining $1 million would come from private sources.

Already, a couple of prominent state health foundations have voiced support, and proponents are confident private donations would bring the program up to the required $6 million.

The driving forces behind the initiative are Working Partnerships, a labor-affiliated group in Silicon Valley, and People Acting in Community Together (PACT), a faith-based organization backed by 15 churches in San Jose.

"There is this fabulous wealth being generated here" in Silicon Valley, says PACT board member Susan Price. "But what is often overlooked is that there are whole pockets being left behind."

Working Partnerships estimates that about 14 percent of children in San Jose are uninsured. Of that group, two-thirds qualify for state-subsidized healthcare programs, but for a variety of reasons haven't signed up. In San Jose, like much of California, low-income groups are made up of large numbers of immigrants who are often fearful of dealing with the state, or simply need help navigating the paperwork requirements and language challenges of the application process.

The San Jose funds would be used partly in an outreach program to sign up those children who qualify, as well as to pay premiums for children of low-income families who cannot afford private insurance but don't qualify for state aid. Many of the working poor here are above the national poverty line, but struggle to make ends meet in an area with sky-high housing costs.

Educators are particularly enthusiastic about the plan. A number of school superintendents have publicly endorsed the initiative, citing the link between the health of children and their performance in school.

"When you support children, you're investing in public education," says Colleen Wilcox, superintendent of schools for Santa Clara County.

(c) Copyright 2000. The Christian Science Publishing Society

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