A county offers health coverage for every kid

In Silicon Valley, officials set aside tobacco-settlement windfall to ensure that all youngsters receive healthcare.

Despite its wealth, Silicon Valley is home to about 70,000 children without healthcare insurance.

That will soon change with the establishment this week of the nation's most ambitious local program to provide universal health coverage for every child under 18.

The program, which faltered earlier this year, now has the financial and political commitments needed to begin in a few months. It has grown from an initial effort to cover children in San Jose, Calif., to one that will provide coverage for all uninsured children throughout Santa Clara County, which includes San Jose.

"We think this is a national model, using local initiative to respond to the healthcare needs of kids," says county supervisor Jim Beall, a key backer of the program. "It's a done deal; we start signing up kids Jan. 1."

The program is unprecedented in its size and scope, healthcare experts agree.

"This sounds like a very promising program in the sense that states across the country have had a great deal of difficulty enrolling children in healthcare programs," says Joel Miller of the National Coalition on Health Care in Washington. "It's very wise for counties to pick up the ball and try to address these needs."

The needs, nationally, are sizable.

About 10 million children in the United States are without healthcare insurance, despite a decade-long economic boom, extraordinarily low unemployment, and a substantial new federal program to increase coverage for those under 18.

The good news is that from 1998 to 1999, the number of youths without insurance declined by over 1 million. Still, with healthcare premiums rising at 12 percent annually and the economy apparently beginning to slow, many experts worry the population of uninsured children could start expanding again.

Mr. Miller points out that the problem in many instances is that families are simply not taking advantage of health programs already offered by states and the federal government.

The federal Children's Health Insurance Program, signed into law in 1997, allocated $24 billion over four years to help states enroll more poor children in health-insurance plans.

Yet this year, a number of states are at risk of losing portions of their federal dollars simply because they have not been put to use. One of the key issues, says Miller, is that states have not done enough to make poor families aware of the coverage now available.

In Santa Clara County, for example, close to two-thirds of the 70,000 uncovered children are estimated to qualify, by virtue of their low family incomes, for one of three subsidized programs.

But in immigrant-heavy states like California, language barriers, the stigma of needing government help, and simply the fear of government all play roles in reducing enrollment for those who qualify. California, which has one of the nation's highest rates of uninsured children, is in danger of losing $550 million in federal aid to insure children because the money has gone unspent this year.

The effort in Santa Clara County, home of Silicon Valley, is possible because of windfall revenues from the 1998 national tobacco settlement and a state tax California voters levied on tobacco users in 1998.

From those two sources, the new program will reap about $5 million for the next year. A total of nearly $8 million, including $1 million pledged by a local HMO and $1.9 million from the county, will cover the first year costs of the program, says Beall.

The initial push will be to sign up children who already qualify for the government-backed Medi-Cal and Healthy Families programs.

"We're going to be out there on every door step, just like the census takers," vows Beall. Schools and churches will be key points for disseminating information, program officials add.

After the first year, costs will begin to rise as the program goes beyond the sign-up phase to actually paying insurance premiums.

Roughly 10,000 children in the county do not qualify for any existing program, and it will cost about $1,000 annually per child to provide insurance, say program officials.

The plan hit a pothole earlier this year when San Jose Mayor Ron Gonzales balked and the city council refused to contribute $2 million, arguing in part that healthcare was a county, not a city, responsibility.

The effort's success is due to an unusual local coalition. Working Partnerships, a local think tank affiliated with the labor movement, and People Acting in Community Together, a faith-based community organization of more than a dozen local congregations, have backed the program.

(c) Copyright 2000. The Christian Science Publishing Society

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