The Chronicle Marathon
Sunday, June 10, 2001

Editorial
Caring for our kids - To healthier families

Once President Clinton's universal health-care reform fell apart, he lowered his ambitions to a simple goal: to at least assure coverage for low- income children.

Regrettably, even that modest concept has proved elusive. Untold millions of children are not getting government-subsidized health care because of their immigration status or because their parents are not aware such help is available. Or perhaps their parents or guardians are simply caught in a common trap of the working poor: They earn too much money for their children to qualify for subsidized health care, yet their household budgets are too squeezed to handle a monthly insurance premium.

Someday, hopefully, the federal government will recognize the myriad reasons why the health of our children is a national concern. Kids who see a doctor regularly and get preventive care tend to do better in school and are less likely to expose others to illnesses. They are less likely to have undiagnosed vision or hearing problems that can be mistaken for inattention. Best of all, they are more likely to get a diagnosis and treatment early, when it is more effective and less expensive.

At least one county, Santa Clara, has seen the need to fill in the gap left by the state and federal governments. San Francisco may soon follow suit.

Here is the situation, and why local governments have been forced to pick up the pieces:

Clinton's 1997 Children's Health Insurance Program (CHIP) -- known as "Healthy Families" in California -- was supposed to provide coverage for children of the working poor. That program got off to a slow start in this state, as then-Gov. Pete Wilson's administration set up an overly bureaucratic enrollment process and offered little in the way of outreach to potentially eligible families. The application itself was almost two dozen pages.

The enrollment process has been streamlined somewhat under Gov. Gray Davis, but the immigrant-hostile Proposition 187, passed by voters in 1994, prohibits coverage for undocumented children. This leaves many working-poor families in a predicament. A family of six, for example, may have two children who were born in the United States -- and thus eligible for "Healthy Families -- and two who were not.

Moreover, the parents may be in this country illegally, and may be wary about applying for a U.S. government program, even if it means their children go without health insurance.

It seems that "Healthy Families" is, if not an oxymoron, a false promise.

Santa Clara County is doing something about it. Starting this year, the county has committed $3 million of its tobacco settlement windfall to a program designed to find and help the estimated 70,000 children who do not have health insurance. San Jose is chipping in $1.4 million, the county will use $2 million from the Proposition 10 (1998) tobacco tax revenue and another $1 million is coming from private foundations.

The county's promise? It will assure health insurance to children in homes at or below triple the poverty level -- or roughly a yearly income of $54,000 for a family of four.

Leona Butler, chief of the Santa Clara program, said "major outreach" has been the key to its "incredible success" in getting health insurance -- including dental and vision -- to 4,000 children who otherwise would not be eligible. A majority of those children are immigrants, according to Butler. She noted that the outreach effort has also helped boost enrollment of "Healthy Families" and other existing government insurance programs.

Santa Clara sends a clear and powerful message to the community.

If you:

-- Live in Santa Clara County;

-- Are age 19 or younger;

-- And do not have insurance . . .

Then county workers will help you get insurance, Butler said. Santa Clara has reduced its application to two pages.

San Francisco may soon try a similar program. Mayor Willie Brown's recently unveiled budget includes $3 million to provide health insurance to children who fall through the gaps. San Francisco, with about 9,000 uninsured children, does not approach Santa Clara County in the magnitude of its challenge.

Dr. Mitch Katz, San Francisco's public health director, openly acknowledges that the annual expenditure will grow from $3 million as word of the program spreads. "Everyone who's eligible will not enroll from Day One," said Katz.

Yet, he is also quick to point out -- quite rightly -- the cost of the program will be partially offset by the savings in the costs of emergency-room visits, when families without insurance arrive in desperation for treatment. Even the most tight-fisted HMO regards preventive medicine as a wise expenditure.

Santa Clara County should be commended for leading the way in making this investment in children's health. It ought to tug at San Francisco's conscience to hear Santa Clara County's Butler say "how lucky we are to have a progressive group of people here."

San Francisco should do no less for its children.