http://www.latimes.com/news/local/la-me-health4jan04,0,7619445.story?track=tothtml
Gov. to seek insurance for all children
Illegal immigrants would be covered in his plan to
overhaul the state healthcare system.
By Jordan Rau
Times Staff
Writer
January 4, 2007
SACRAMENTO - Gov. Arnold Schwarzenegger
will propose that all Californian children, including those in the state
illegally, be guaranteed medical insurance as part of the healthcare overhaul he
intends to unveil next week, according to officials familiar with the
plan.
If enacted by the Legislature, his proposal would affect about
763,000 children who now lack insurance. Although the administration has not
revealed details of how it would pay for such a program, officials estimate that
extending insurance to all children could cost the state as much as $400 million
a year.
That would be a small piece of Schwarzenegger's stated goal: to
ensure medical coverage for all of the 6.5 million Californians who now have
none. Experts say that could cost upward of $10 billion a year.
If
successful, the governor's effort to cover all children would be a substantial
political feat. Only a few states guarantee coverage for all those under 18.
Schwarzenegger himself vetoed a measure to cover all children in 2005,
complaining that lawmakers offered no way to pay for it.
California's
Republican legislators, who blocked a more modest effort to extend healthcare
coverage last year, are sure to rebel against a plan that includes children of
illegal immigrants.
Schwarzenegger is scheduled to
announce his full health plan Monday. His office is still finalizing many parts
of that package, but aides have made clear that it will be an ambitious effort
to restrain healthcare costs and reduce the state's uninsured
population.
All sectors of the healthcare industry, including hospitals,
insurers, doctors, patients, businesses and government, would pay some of the
costs under Schwarzenegger's plan. People familiar with the proposal say that it
includes new requirements for businesses to cover employees, though the details
were unclear. The more cost shouldered by employers and workers, the less the
state would have to spend.
In addition, a number of measures favored by
some aides, such as limiting the profits
of insurers, remain
undecided.
"There is no final health plan," said Adam Mendelsohn,
Schwarzenegger's communications director. "As has been the case from the start,
all ideas are on the table and the final touches are being applied. The
administration is not confirming the inclusion of any one piece."
But
several independent sources said Schwarzenegger had committed to the framework
of the children's insurance portion. Administration officials have privately
told people outside government that they intend to guarantee medical coverage
for children of families earning up to 300% of the poverty level, or $60,000 a
year for a family of four. Those families have 90% of the children without
insurance. But the cutoff is not yet set in stone.
Schwarzenegger's
proposal goes further than one put forward last month by Senate President Pro
Tem Don Perata (D-Oakland). His plan excluded illegal immigrants. Assembly
Speaker Fabian Nuņez (D-Los Angeles) incorporated children of undocumented
residents into his plan, which also was announced in December.
"A lot of
us are really looking to [Schwarzenegger] for leadership," said Wendy Lazarus,
founder of the Children's Partnership, a nonpartisan child advocacy group based
in Santa Monica and Washington, D.C. "Assuming he is going to tell us that he is
going to cover all kids, this is great news for California's kids."
About
90% of California's children already have insurance, either through their
parents' coverage or through state Medi-Cal programs that help the impoverished.
For years, advocates have been pressing lawmakers to finish the job, arguing
that the electorate would be sympathetic to the plight of children.
"It's
the low-hanging fruit of the healthcare reform debate," said Dr. Bob Ross,
president of the California Endowment, a private foundation in Los Angeles that
was created to push for expanded access to healthcare.
"Kids are
relatively cheaper to cover" than adults, he said. "From a public health
standpoint, it's smarter to cover all children regardless of immigration. You
just don't want unimmunized kids surfing around in the population."
Such
arguments have yet to win the day in Sacramento. Last year, Schwarzenegger
backed a budget plan that would have helped fund local children's initiatives.
Republican lawmakers blocked the proposal, because it would have included
coverage for children of illegal immigrants.
"We believe Californians do
not want to reward illegal behavior," said Assembly Republican leader Mike
Villines of Clovis. "There are so many here [legally] who are hurting and trying
to make ends meet, we've got to focus on them first."
The GOP is a
minority in both houses of the Legislature, but most proposals involving state
spending require a two-thirds vote, giving Republicans the power to stop them.
However, it is possible that Schwarzenegger's plan could be molded to need a
simple majority vote, like the last major piece of healthcare legislation to
become law.
That measure, a 2003 mandate that most employers provide
insurance for their workers, was repealed by voters the following
year.
Schwarzenegger has taken incremental steps to expand existing
programs aimed at children's health, including the addition of $80 million to
the state budget last year.
Martha Escutia, a former Democratic state
senator from Whittier who pressed for coverage of all children, including those
of illegal immigrants, said Schwarzenegger told her in 2004 that he agreed with
her.
"I said very bluntly that there was no way we could distinguish
between children based on legal status," she recalled Wednesday. "And the
governor agreed. He said, 'Children are children.' I remember him saying that
very clearly."
Sixty-nine percent of Californian children without health
insurance in 2005 were eligible for existing programs but were not enrolled,
according to the UCLA Center for Health Policy Research.
That was due to
a variety of factors, including inadequate funds in some county programs to
cover all those who qualified, and some of the bureaucratic requirements for
entering state programs.
Many parents, for instance, are required to
prove that their earnings are low enough to qualify their children.
There
is disagreement about how many of the uninsured children are here illegally. A
2003 UCLA survey said that 33% were not citizens, but that does not mean that
they were in the country illegally. Ross, of the California Endowment, said the
number was below 15%.
Most of the other states that already guarantee
coverage for all children do it through state-paid programs for those from poor
families, and by allowing better-off families to cover their children by paying
a portion of the costs for the same programs.
Typically, the more a
family earns, the more it pays. Connecticut, Illinois, Maine, Maryland, New
Hampshire, New Jersey and Vermont all have such programs.
Lazarus, of the
Children's Partnership, said that although California would not be the first to
cover all children, it has fewer employers providing insurance and more illegal
immigrants than other states, making coverage more challenging.
"For
California to step up at this time when states and Congress are really focused
on healthcare reform means that California could have a really significant
leadership role across the nation," she said.
jordan.rau@latimes.com
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(INFOBOX
BELOW)
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$400 million
projected cost of extending
insurance to all California children
763,000
uninsured
children would qualify for coverage
6.5
million
Californians have no health insurance