An expected presidential veto of a bill that would boost spending on a children's health insurance program could leave hundreds of thousands of California children without coverage, health experts say.
The result would be disastrous for California, said Anthony Wright, executive director of Health Access California, a nonprofit organization that advocates for affordable health care. Without additional funding for the program next year, as many as 250,000 California children could be dropped, he said.
The federal government's State Children's Health Insurance Program, or SCHIP, provides low-cost health coverage for about 6.6 million children nationwide.
More than 831,000 children from working families statewide are covered by the program, known in California as Healthy Families. More than 53,000 children in the central San Joaquin Valley are enrolled.
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The children are from families who cannot afford private insurance but earn too much for Medi-Cal, the state's insurance program for the poor. In California, children are eligible in families with earnings of up to 250% of the federal poverty level, or about $52,000 a year for a family of four.
The program expires Sunday, but state officials said they expect Congress to provide money to continue services at current levels though the end of November.
The worry is that flat funding could continue well beyond that -- even as the cost of health care rises and the number of eligible children grows.
Without extra federal money, "we will have to look seriously at disenrolling children next year," said Amy Palmer, associate secretary for external affairs at the California Health and Human Services Agency.
President Bush has vowed to veto a bill approved Thursday by the Senate and earlier in the month by the House that would give the children's insurance program $60 billion nationwide over the next five years, an increase of about $35 billion. The increase would have covered an additional 4 million of the nation's 9 million uninsured children.
The president has said the increase is too costly. He has proposed giving the program $30 billion, an increase of $5 billion.
California officials say the president's proposed $30 billion would not be enough for California to sustain its program.
"That just doesn't cut the mustard for California, and it doesn't cut the mustard for most of the states in the country," said Lesley Cummings, executive director of the Managed Risk Medical Insurance Board, which oversees California's Healthy Families program.
Without adequate funding, "we're going to have to look at options for cutting back the program," Cummings said.
California was counting on federal funds of $6.7 billion to $8.1 billion over the next five years to maintain the program. The bill approved in Congress would provide that. The program cost about $1.1 billion this year.
The state had hoped for even more so that eligibility requirements could be loosened.
About 763,000 California children were without insurance in 2005, according to California Health Interview Survey conducted by the University of California at Los Angeles. Of that number, about 200,000 were eligible for Healthy Families but were not enrolled.
State officials also could be scrambling to rewrite the governor's health-reform plan if the Healthy Families budget remains flat, said Wright of Health Access.
"It means health-care reform is going to be tougher," Wright said. "We have to raise money from other places -- raise more dollars in-state."
The governor's health-reform proposal includes an estimated $42 million in extra children's insurance money from the federal government to insure about 50,000 children. But the children's health money is only a small part of the billions in federal funds the governor hopes to tap for health-care reform, Palmer said.
The bigger issue, she said, is the potential for children to be dropped from the program for a lack of funding. "At a time when we are moving to cover all children in California, anything that undermines our Healthy Families program -- whether it is a reduction in funding or stricter program rules -- is a problem for us in California."
The budget fight in Washington could unravel the program in California, said Bill Knezovich, pastor of Our Saviour's Lutheran Church and a leader in Faith in Community, the Fresno arm of People Improving Communities Through Organizing, an interdenominational group with about 20 churches in the Fresno area.
Knezovich has traveled to Washington four times to seek more funding for the children's insurance program. Knezovich's church is a registration site for Healthy Families. About 50% of his congregation has children enrolled in Healthy Families, he said.
"These people are hardworking people who a lot of times have to make a choice between food, clothing and health care," he said.
"Healthy Families has been one of the best programs that has come about," he said. "I just don't understand how we can't seem to do something that is good and just for hardworking people."
Rosalinda and Jesse Cabrera of Fresno enrolled their three children in Healthy Families four years ago.
"We couldn't afford the insurance by ourselves, coming out of our pockets," said Rosalinda Cabrera. "We're not that well off right now."
Cabrera, 31, works part time at three jobs, one at a school and the others at retail stores. Her husband is a truck driver. Together, their income is about $2,500 a month, she said.
Jesse Cabrera's employer offers health insurance, but the family cannot afford the monthly premiums, Rosalinda said. Her employers do not provide insurance to part-time employees, she said.
Healthy Families is a good program, she said. "If I didn't have this, what would I do?"