San Francisco Chronicle
Wednesday, December 26, 2001

New S.F. health insurance for kids
County-run project one of two in state
By Sabin Russell, Chronicle Medical Writer

San Francisco -- Starting Jan. 1, for $4 a month, Carmen Escobar will be able to buy some peace of mind at last.

With the beginning of the new year, Carmen and thousands of other families in San Francisco -- about half of them undocumented immigrants -- will be offered health insurance for their children.

"There is excitement in the community," said Escobar, who lives in the southwest corner of San Francisco, a block from the Daly City boundary. "They've heard whispers that a new program is coming."

Modeled after a pioneering project begun this year in Santa Clara County, the new Healthy Kids program will make San Francisco the second county in California to offer nearly universal health coverage for children.

The initial estimated cost of $2 million will provide a year of heavily subsidized medical, mental health, dental and vision coverage to children up to age 18 who don't qualify for the broad patchwork of programs already available.

The program will serve children whose working parents make too much money to qualify for either Medi-Cal or Healthy Families. Medi-Cal is the state and federal health insurance program for the poor; Healthy Families offers low- cost coverage to households that can't afford health insurance but make too much money to qualify for Medi-Cal.

There are 10,000 uninsured children living in San Francisco. About half of them qualify for those existing programs, and the rest can be covered by Healthy Kids.

"We're hoping to enroll about 750 children per month until we've enrolled all the kids we can," said Jean Fraser, chief executive of the San Francisco Health Plan, the county agency that runs Healthy Families and will operate Healthy Kids.

San Francisco has budgeted $2 million this year for the new program, which could cost $6 million if all the eligible children are eventually enrolled. Most of the money will come from the general fund, although in the next two fiscal years, $1 million will be drawn from cigarette taxes raised through Proposition 10.

For working mothers like Escobar, the new program could end a terrible dilemma -- her young daughter already qualifies for health coverage in San Francisco, but her teenage son does not.

Seventeen-year-old son Marvin, a broad-shouldered athlete with dreams of playing center field in the major leagues, has had no health insurance for two years, after his father's coverage played out at the end of a divorce settlement.

"He's generally healthy," said Carmen through a translator, "so I feel lucky. But if he is sick or injured, I can only get 'emergency care' at San Francisco General Hospital. There is no preventive care, no dental, no drug coverage."

The last time Marvin was ill, she was billed $60 for the doctor visit, plus the cost of prescription drugs. She worries that, as a teenage boy, he is at risk for serious injury or could come down with an illness she could not afford to treat.

Her 4-year-old daughter, Paola, has been covered by Medi-Cal since her birth at San Francisco General Hospital. But Marvin, who came with his mother from a little town in Nicaragua when he was 12, does not qualify for any health insurance programs, which are limited to American citizens and legal immigrants.

While San Francisco fancies itself a pioneer in social experiments, the city is following in the footsteps of Santa Clara County, which began the first-in-the-nation Healthy Kids program one year ago.

"We've definitely exceeded our projections," said Rosemary Barnes, marketing director for the Santa Clara Family Health Plan, which runs Healthy Kids in the South Bay communities. The county estimates that 18,000 children qualify for the program. This year, they hoped to sign up 6,500. "By month's end, we will have close to 8,500," said Barnes.

Mario Moreno, community relations manager for the San Francisco Health Plan,

was hired from Santa Clara's program. He says the Healthy Kids program gives parents what they've needed. "When I say, 'It covers dental,' you can see the spark in their eyes," he said. "They say, 'Where do I sign?' "

Melinda Paras, executive director of Health Access, a health care advocacy group based in Oakland, says insuring all children is an important first step. "It is the start of something very important," she said. "It is getting the concept of universal health care back into the vocabulary."

Lucien Wulsin, director of the Uninsured Project based in Santa Monica, says counties across the state are poised to follow San Francisco and Santa Clara. "The tough question for the counties to deal with is, 'Where's the financing?' "

Children are the least expensive demographic group to insure, but it still costs about $1,000 per child to provide a year's coverage. Santa Clara County tapped both public and private sources to meet its $9.5 million budget -- including a $1.9 million grant from the David and Lucile Packard Foundation.

In austere fiscal times, though, keeping up the financing may prove difficult.

"It's the federal and state governments who have the money," said Wulsin. "Counties don't."

San Francisco public health doctors point out that much of the money for child health care is already available but is spent inefficiently.

Dr. Jamie Ruiz, staff pediatrician at the Mission Neighborhood Health Center in San Francisco, says he expects to see many of the same kids on the Healthy Kids program that he already sees today. What will be different, he says, is that he can spend his time giving medical care, not sorting through paperwork.

Parents will face fewer hassles, and will be more likely to bring their children in for preventive care.

"It will be a big improvement," he said. "Everybody here is looking forward to it."

San Francisco Department of Public Health Director Dr. Mitch Katz says the program will be "using existing dollars in a better way."

Nevertheless, he says, funding universal health care for children should not be a county responsibility.

"There's something a little sad about a county doing what the federal government should be doing," he said. "But I'm glad I live in a county that's doing it."

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