"Healthy Kids" Insurance
Praised by Fla. Parents

By Nancy Weil
American News Service

When Kathie Shepard left her job as a Florida teacher six years ago because of health problems caused by diabetes, her family plunged into desperate times.

The children, Christopher and Cecelia Earl, no longer had health insurance. Christopher, now 8, has an immunity anomaly that makes him prone to infections. He also suffers from skin allergies and respiratory problems, including asthma. Shepard and her husband, John Earl, a self-employed carpenter, couldn't find affordable insurance that covered Christopher's pre-existing condition.

"We did everything right," Shepard said of the years before they lost health insurance. "We had two kids, a dog, a house, a station wagon. We were living the middle-class dream."

But the dream turned into a constant nightmare over how to pay for Christopher's frequent trips to the doctor and prescription medications.

Then, five years ago, as Shepard and Earl decided there was no hope, Cecelia, 13, came home from school with information about the Florida Healthy Kids Corp., a state-subsidized nonprofit program that provides comprehensive health insurance to school-age children and their siblings.

"It's a wonderful program,'' said Shepard, who is convinced her family would have had to sell their home to keep up with Christopher's ongoing medical care.

Shepard and Earl weren't alone in their plight. In Florida, one-quarter of all school-age children are uninsured. Nationally, 10 million children -- one in seven -- are uninsured, and two-thirds of those come from working families with incomes above the poverty level, according to a U.S. Governmental Accounting Office report.

As more companies scale back coverage for employee dependents, raise the cost of such coverage or eliminate the option altogether, those numbers are expected to rise.

While serving as a national model, the Florida health plan is unique in both its scope and strategy, say insurance and child welfare specialists.

Unlike pending federal proposals, the Florida program uses school districts to create insurer groups, disseminate information and administer the program. The idea is that schools can extend health insurance to large numbers of children in the same way businesses do for adults.

Another distinctive feature is that all students lacking health insurance, not just those from poor families, can sign up for the program. That is how the Shepard and Earl family, with its above-poverty-level income, qualified to be part of Healthy Kids.

In Washington, a proposal to insure up to half, or 5 million, of the nation's uninsured children, has been fastened to the budget bill in Congress. Similar efforts are spreading locally, with subsidized health insurance now offered to eligible children in 38 states, either through private or government agencies, a recent U.S. News & World Report examination found.

Under Florida's school-administered plan, families pay a monthly premium per child, based on household income. The minimum premium is usually around $5, with an average of $51 monthly per youngster, and there is also a nominal co-payment for visits to the doctor and prescription drugs.

=46amilies whose children qualify for free and reduced school meals under th= e federally subsidized program pay in the lower range of premiums. But the only qualification for coverage, which includes everything from immunizations and preventative care to organ transplants and pre-existing conditions, is that the child not have other medical coverage.

As of May 1, there were 36,077 Florida school children enrolled in Healthy Kids in 16 of the state's 67 counties, according to Rose Naff, the program's state executive director. Youngsters in cities like Miami, Fort Lauderdale and St. Petersburg, and smaller communities like De Land where Shepard and Earl live, are covered. Those 16 counties have 1.1 million children, or half of the state's school-age population.

Another 5,000 new applications are being processed from the 16 counties, and this summer, Hillsborough County, which includes Tampa, will join the list of school districts that are part of Healthy Kids. Children who attend private schools in participating counties are also eligible for the program, whose $24-million budget -- $13-million from the state and $11-million from parent contributions and community matching funds -- is expected to increase by $8 million for next year, Naff said.

=46or its investment, Florida saved taxpayers and hospitals more than $13 million in health care costs in the last year alone, according to an independent study done by the Institute for Child Health Policy at the University of Florida.

The study found hospitals reporting a 30 percent decline in pediatric charity cases and, even more striking, a 70 percent decrease in emergency room visits the first year that Healthy Kids starts in a community. More than 90 percent of the families whose children are enrolled said they were either satisfied or very satisfied with the program.

Instead of missing school or, perhaps worse, going to school sick, youngsters receive medical care from a primary physician who knows them and their histories. Vision and hearing problems are detected. Allergies, asthma and other maladies common to children get taken care of before they degenerate into serious chronic problems.

Despite impressive statistics, Healthy Kids has its detractors, notably =46lorida state Rep. George Albright III, Republican chairman of the Health Care Services Committee. "I think it does a good job, but I'm paid to be skeptical," he said.

Albright said he wants to make sure costs stay under control and ensure that Healthy Kids doesn't become another entitlement program at a time when government is scaling back such assistance.

In May, Albright won passage of a five-year limit on benefits to all youngsters enrolled from now on. Those already in the program are not affected. Albright called the five-year cap a "safety valve."

"Perhaps I don't understand what an entitlement is," program director Naff said sarcastically, responding to Albright's criticism. "This is a program where everybody is paying (a monthly premium). I don't know any entitlement programs where that is the case." =20

Last year, the Florida Healthy Kids Corp. was given the prestigious Innovations in American Government Award from the Ford Foundation and the John F. Kennedy School of Government at Harvard University. The Robert Wood Johnson Foundation, the nation's largest philanthropic foundation devoted to health care, helped transform the Florida Healthy Kids Corp. into a national office and has made available $3 million in grants to help other states adopt the Florida model, the country's first.

Thirteen states -- Arkansas, California, Colorado, Georgia, Illinois, Iowa, Louisiana, Missouri, New Hampshire, North Carolina, South Carolina, Texas and West Virginia -- applied for funding through the new national office. Seven states will receive funding, to be determined by a national advisory board in November, according to Naff, who coordinates both the national and =46lorida programs.

The program is considered cost-effective for participating doctors, too, because it reduces the number of indigent children they treat without hope of being paid. More than that, though, physician Yolanda Dreier says it helps her to better manage the ongoing health care of her young patients.

The Volusia County pediatrician, who counts Christopher and Cecelia Earl among her patients, knows exactly how their parents feel. When she was a child, she and her younger sister had no health insurance. Although they eventually did get coverage when her father got a job with the fire department, the family couldn't afford the cost of open-heart surgery for her sister and had to sell their home.

"It's taxing not only from a financial standpoint, but from an emotional standpoint," Dreier said. "You want to do the best for your children, and Healthy Kids provides that for these people at a nominal cost.''

=20 SIDEBAR Concept Uses School District As Medical Coverage Group =20 The idea of school enrollment-based health insurance was proposed in a 1988 article in the New England Journal of Medicine. Two years later, state health and education officials began pushing the idea in Florida, where it found widespread bipartisan support.

"The concept is simple," says the Healthy Kids 1996 annual report. "Most American children attend school. School systems can be used as a mechanism for creating large groups of people to cover.. the way large businesses do." In Florida, that means children in the individual county school districts become their own group for health insurance coverage.

Communities have to come up with matching funds to participate in the program, from a minimum of 5 percent to a maximum of 40 percent of the total state allocation for the county. Health care organizations and networks make bids to cover children in the Healthy Kids counties, just as a large company seeks bids before settling on group coverage for employees.

Keeping the matching grant funds rolling in can be a challenge, say those who are trying to do just that, though programs such as the United Way have been helpful, as have corporate sponsors. And, even though Healthy Kids is a state program, it is administered by county school districts, which adds to employee work loads. However, those involved in Healthy Kids at the county school district level say the task of administering the program gets easier with time.

"Now that we have the process in place, it's much smoother and it takes less time," said Marion Plichcinski, assistant superintendent for elementary education and student services in Pinellas County, which includes St. Petersburg. Districts disseminate information to families during the open enrollment period, usually each spring.

"I haven't heard from any parents who say it's not working for them, that they have to wait a long time (for their children to see a doctor) or travel long distances or anything like that," said Plichcinski.
Copyright ©1997 American News Service
Posted June 30, 1997

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  • Children's Defense Fund includes child health insurance statistics and summary of legislative proposals)
  • Institute for Child Health Policy
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