"As state budgets face monetary shortfalls, taxpayers should know it is cheaper to cover kids with health insurance than cover expensive hospital costs for uninsured kids." - Barbara Luksch, Hawaii Covering Kids project director "Children who have no regular access to a doctor are more likely to come down with diseases they could spread. Society now wastes money when uninsured families take children to hospital emergency rooms for problems that could have been solved earlier in a doctor's office. We all end up paying for this health care one way or the other. The question is, are we going to be smart about it?" - Tom Vilsack, Iowa former governor "As it stands, these untreated kids suffer until it's clear that something must be done and then they wind up in hospital emergency rooms treated with some of the highest-cost health care in the world. Their families can't and don't pay those costs; they are foisted on the hospitals and their paying patients.”" - Editorial Board, The Oregonian "Hospital administrators expect to provide even more uncompensated care--charity care plus unpaid bills--this year especially in emergencies for those who couldn't afford preventive care." - Lisa Rosetta and Heather May, The Salt Lake Tribune 1. Keiki Care Ultimately Helps Hawaii Families and Economy Imagine your child awakens in the night with an asthma attack and needs health care. The coughing and breathing worsen--however, your child has no health insurance. You struggle to pay for food, rent and other basic living expenses and are fearful of the hospital emergency room because of potentially ruinous medical bills. What do you do? Read our entire op-ed article in the Honolulu Star-Bulletin. 2. Oregon: Is It Going to Care for Its Sick Kids, or Not? There's a fundamental question embedded in the state budget proposed this week by Gov. Ted Kulongoski: Is Oregon prepared to provide health insurance for the more than 100,000 kids in this state who have no coverage, and in many cases, no care? Or is it going to keep telling kids, sorry, but it's just too expensive to treat your diabetes, too costly to control your asthma? Yes, it will cost money. Kulongoski is proposing an increase in provider taxes on hospitals and health insurers in Oregon to pay to extend health care coverage to about 95 percent of the uninsured kids in the state. Predictably, the governor's Republican critics are attacking him for proposing tax increases during a recession. These are the same critics, of course, who attacked him for proposing tax increases for children's health care two years ago when the economy was strong. But how fair is it to tell a child in this state that you're just going to have to live with a chronic and disfiguring skin disorder, because we're not going to lift a finger to help your low-income parents pay your health care costs? It's appalling that Oregon even has to have this debate about providing basic health care, including preventive dentistry, for more than 100,000 children. Yes, this issue is bigger than Oregon and its kids. Of course, the nation must overhaul its entire system of health care. But the immediate question for Oregonians is whether we do anything for uninsured kids between now and whenever the federal government manages to reform health care. Kulongoski's position is that the right and moral thing to do is help these kids now, and not just tell them to wait, wait, wait, for a federal solution. He's right. Last year, when legislators tried to get this job done with a cigarette tax increase, we kept hearing how it wouldn't be sustainable, and we're sure to hear the same tired argument about the governor's new plan to pay for children's health care. Well, so what? This is not about creating a revenue stream to pay for children's health coverage forever more. It is about helping these sick kids, who have untreated asthma, rotting teeth and other maladies, until a better system is in place. The expanded provider tax makes some sense as a funding mechanism. As it stands, these untreated kids suffer until it's clear that something must be done, and then they wind up in hospital emergency rooms, treated with some of the highest-cost health care in the world. Their families can't and don't pay those costs--they are foisted on the hospitals and their paying patients. You watch, there's going to be a big ugly fight in the next Legislature over the governor's children's health initiative. Republicans will use the issue to club the governor and Democrats for their big-spending ways. Hospitals will object. Yet the opponents won't offer any better way to cover uninsured kids. You're just going to hear that Oregon can't afford it, that it can't do this now, that the money should come from somewhere else in the budget, that it's the federal government's responsibility. Translation: Sorry kids, you're on your own. If that sounds cold, well, that's long been the official policy of this state. And Oregonians can no longer pretend they don't know where that leads: to more than 100,000, and counting, children with no health care insurance. [Editorial Board, The Oregonian, 12/04/08] 3. Iowa: Don't Drop Health Care Changes Iowa should press ahead with plans to provide health insurance to all children, despite state budget problems, health reform advocates say. The Legislature last year agreed to expand public health insurance programs to cover more children from moderate-income families. Lawmakers voted to spend nearly $5 million for the effort during the current budget year, and they plan to increase that to $15 million for next year, then $25 million for 2010. That money would be on top of automatic increases in public health care spending for families that become impoverished because of the national recession. "Now is not the time for the state to be telling people, 'Sorry, we can't help you cover your kids,'" said Carrie Fitzgerald, a senior health policy associate for the Child and Family Policy Center. Fitzgerald also is chairwoman of a state committee that will recommend ways to cover uninsured Iowans. The first target is the approximately 38,000 children who lack health insurance. The state costs could ease if the federal government agrees to increase its subsidies of children's health care. But either way, the effort would require more state money. House Majority Leader Kevin McCarthy, a Des Moines Democrat, said the Legislature intends to move forward with the effort, even as it cuts other programs. "We're going to have to prioritize, and I can tell you that health care, particularly health care for children, is one of the top priorities," he said. One of the proposals already approved by legislators is to raise the income limit for families to qualify for Hawk-I, a government program for children whose parents make moderate incomes. The income limit now is about $50,000 for a family of four, which Iowa plans to raise to about $63,000. As it stands now, the state would have to shoulder the whole cost of that move. But supporters are optimistic that Congress will increase federal subsidies and ease eligibility rules for Hawk-I and similar programs. That would mean millions of extra dollars to help the state cover more children. Fitzgerald said she is heartened by the fact that President-elect Barack Obama has voiced support for state child health care programs such as Hawk-I. She noted that he helped create Illinois' version when he was a legislator there. One of the most controversial Iowa recommendations could be that the state open its insurance programs to immigrant children who either are in the country illegally or who have been here legally less than five years. Analysts say Iowa has several thousand such children, and it would join four other states in covering them. Former Gov. Tom Vilsack, who is a member of Fitzgerald's committee, proposed the change this fall as part of the state's goal of covering all children. Vilsack, a Democrat, noted that the state already provides education to children without asking for their immigration status. He said it's logical to do the same for health care. For one thing, he said, children who have no regular access to a doctor are more likely to come down with diseases they could spread. He also said society now wastes money when uninsured families take children to hospital emergency rooms for problems that could have been solved earlier in a doctor's office. "We all end up paying for this health care one way or the other," he said. "The question is, are we going to be smart about it?" Vilsack said he would be less comfortable offering public health insurance to adults who immigrated illegally. Those people made a choice, he said, but their children did not. The advisory committee Vilsack serves on voted 6-3 to support the idea of covering immigrant children. The dissenters included former Gov. Terry Branstad, who resigned from the panel Dec. 1. Branstad, a Republican, is president of Des Moines University. His spokeswoman said he cited several reasons for quitting the committee, including the time commitment. But she said the immigrant-children proposal contributed to his decision, because he thought it went "beyond the scope" of the committee's mission. State Rep. Linda Upmeyer, a Garner Republican who has worked on the health care reform effort, said she doubted the immigrant-child proposal would gain traction at the Statehouse. She said legislators discussed it last year and decided not to include it in the bill that passed. Upmeyer said the Legislature will struggle to come up with enough money just to cover children who are U.S. citizens. "How do you expand a program when you can't afford the one you've already got?" she said. The idea also faces hurdles within Vilsack's party, which controls the Legislature. McCarthy, the House majority leader, said he could support the move if it was part of a national package of immigration reforms. "But as a stand-alone issue, we'd be reluctant to pursue that in the House," he said. Gov. Chet Culver's spokesman, Troy Price, indicated the governor, a Democrat, agrees with McCarthy. "Our first priority is protecting those who are currently eligible for coverage," Price said. "The governor and lieutenant governor are committed to making sure that those currently eligible for these programs are protected before beginning a discussion on expanding coverage to new populations." He added that any move to cover more immigrant children would require federal leadership. Immigrant children are believed to make up roughly 10 percent of uninsured children. Most of the rest already qualify for Hawk-I or Medicaid, the government health care program for poor people. Reformers want to keep looking for ways to get more of those kids signed up. They have streamlined sign-up and renewal and they want to let doctors' offices presume that new patients are eligible until proven otherwise. Sen. Jack Hatch, a Des Moines Democrat who has helped shepherd the health care reform effort, wants to require parents to sign up their children for state programs if they qualify. When the health care reform effort started last year, Hatch pushed for a requirement that all Iowa parents insure their children. But that proposal was stripped from the plan in the Legislature. Hatch said he would not initially favor penalties for parents who failed to sign children up for state programs, but he said sanctions could be considered in the future if large numbers of qualified children remained uninsured. Iowa's health reform effort also includes numerous other initiatives, such as plans to help small businesses offer coverage, to let consumers see which health providers offer the best quality and price, and to encourage the use of electronic medical records. [Tony Leys, Des Moines Register, 12/14/08] 4. Utah: Unpaid Bills Mounting at Hospitals Codee Marshall's 3-year-old daughter, Ali, suffered a traumatic head injury in August when a horse stepped on her head, shattering her skull. With no health insurance, the family sought charity care to cover the hospital bills, which Codee Marshall estimates were between $200,000 and $300,000. With the state's housing market in peril, bankrupt builders were not paying what they owed Codee and Jim Marshall's heating and air conditioning business. When the business failed earlier this year, the Marshalls lost their South Jordan home, two rental properties and their health insurance. So the family had no coverage in August when their 3-year-old daughter's skull was crushed by a startled colt on the family's Lehi farm. Ali was flown by Life Flight to Primary Children's Medical Center in Salt Lake City, where she spent a month undergoing surgeries and recovering. The Marshalls joined the growing number of Utahans who can't afford to pay their medical bills. They applied for charity care to forgive their debt, which Codee Marshall estimates is between $200,000 and $300,000. As the ranks of the uninsured and underinsured swell, the state's four major health systems report they have seen their charity care grow in the past five years by 148 percent. Intermountain Healthcare alone, which includes Primary Children's, saw the charity care it grants nearly double between 2003 and 2007, from $53.7 million to $101.2 million. More often, hospitals are left with unpaid bills. Patients owed Intermountain $153.7 million last year, a 106 percent increase from 2003. Hospital officials say those who are insured can't afford to pay ever-higher deductibles passed on by their employers. Some of the uninsured refuse to pay. Others don't have the money. "In the end, the responsibility or burden falls to the hospital," said Steve Bateman, chief executive officer of St. Mark's Hospital. Hospital administrators expect to provide even more uncompensated care--charity care plus unpaid bills--this year, especially in emergencies for those who couldn't afford preventive care. "Absolutely we're worried because the economy, potentially for a long period of time, is moving in the wrong direction," said Gordon Crabtree, chief financial officer for University of Utah's hospitals and clinics. "We only have so many beds. Some of those beds have to be filled with patients who have insurance." [Lisa Rosetta and Heather May, The Salt Lake Tribune, 11/30/2008]