Plan to insure kids cut back at Capitol

01/28/2007

Pawlenty had called for health coverage for all uninsured children; now he and the DFL-led Senate are offering more modest plans.


By Patricia Lopez,
Star Tribune
Last update: January 27, 2007


Two months after Minnesota's elected leaders appeared committed to providing health care coverage for all of the state's 70,000 uninsured children, expectations are now being scaled back at the Capitol.

Political fervor for the ambitious plan is wilting in the face of its price tag and competing priorities in health care reform and other issues.

After he won a second term in November, Gov. Tim Pawlenty declared that the path to universal health care coverage "should start with covering all kids," and that, "We now have the resources to do this." DFLers in the House and Senate said they were "thrilled" with the governor's new position and eager to move forward.

But when Pawlenty released his plan earlier this month, it covered 13,000 additional children -- fewer than half the number who lost coverage in his 2003 budget cuts.

Meanwhile, the DFL-led Senate's primary bill this year on the issue proposes covering 20,000 more children, even though the majority there has advocated "Cover All Kids" legislation for years.

Sen. John Marty, DFL-Roseville, who heads the Health, Housing and Family Security Committee, called the shifts a "stunning crash of expectations," but said he still hopes to win support for a plan to cover all children in the state.

Only the House is putting the muscle of its hefty DFL majority caucus behind a bill that would make all uninsured children in the state eligible for coverage.

"We think this can happen," said House Speaker Margaret Anderson Kelliher, DFL-Minneapolis. "Other states have figured this out. Minnesota can too. This is our top priority."

Indeed, such proposals are gaining ground nationwide.

In California, Republican Gov. Arnold Schwarzenegger has proposed insuring all California children -- even those of illegal immigrants. "A child is a child," he said. Illinois passed universal children's coverage last year, and Pennsylvania's plan takes effect this year.

While Pawlenty and the Senate shy away from insuring the state's uncovered children, the House's plan goes far beyond that goal. It aims to reduce family and employer costs by giving state coverage to any child whose parents earned less than 300 percent of federal poverty guidelines -- $60,000 for a family of four.

Swirl of health care troubles

Such a plan seems like a dream to Angela Geske, a 27-year-old New London mother of four whose life has become a swirl of doctor visits, medical bills and constant worry about whether the family will fall out of eligibility for Medical Assistance, as it has in the past.

In the last month, Geske has:

• gotten the cast off the left hand of 8-year-old daughter Elaine, who's on her third surgery for bone cysts.

• taken her two middle children, ages 6 and 5, for weekly therapy visits and medication for recently diagnosed attention deficit hyperactivity disorder.

• bundled off 1-year-old Aric to the doctor for his 19th ear infection. The baby is now being referred to a specialist.

Last Wednesday, Geske was told that husband Mike, who earns $27,000 a year as a door painter, was off to the emergency room. A paint sprayer had backfired in his face, temporarily blinding him.

By that evening, Geske was back to filling out sheets of paperwork for Medical Assistance. Overtime pay that her husband earned in November, she explained, might have exceeded the state's strict financial requirements for assistance, temporarily jeopardizing the family's health care.

Like many low-income families in Minnesota, the Geskes are eligible for insurance through Mike's employer, but at $300 a month premiums plus $40 co-pays and deductibles, they can't afford it without state help.

Jim Koppel, executive director of the Children's Defense Fund, says it's a dilemma no family should face.

"Children are so cheap to cover," he said. For most of them, he said, "it's all about developmental needs: immunizations, well-child visits, nipping chronic ailments in the bud."

Ignoring those needs can result in lifelong problems, he said, and for children with serious health problems, lack of insurance results in $70 million a year in uncompensated costs at the state's hospitals -- costs ultimately paid through taxes and higher premiums for the insured.

No overnight solution

Under the House plan, Mike and Angela Geske could insure just themselves through Mike's employer and put their children on the state health plan. Mike's employer would no longer have to pay premiums for the Geske children. And even if Mike lost his job, the kids wouldn't lose health care.

But the House plan isn't cheap -- about $250 million per year.

Brian McClung, Pawlenty's spokesman, said that the House plan "has a price tag that they might find difficult to cover in the context of everything that goes into a complete budget picture."

While covering all kids remains "a worthy goal," McClung said, "it won't happen overnight." Instead, he said, Pawlenty's plan focuses on "cost-containment, quality and access." It is similar to the Senate's main bill, sponsored by health care veteran Sen. Linda Berglin, who has also said remedies should be broad-based.

Berglin has said she is particularly concerned with older adults too young for Medicare and too poor for private plans.

Proponents of universal children's coverage say it's too soon to give up, but they acknowledge that the fight ahead will be a tough one. The health care system has so many needs, they say, few know where to start.