Public Health Insurance Is There But Enrollment Is Lagging

Gov. Arnold Schwarzenegger (R) is promoting an ambitious plan to provide health coverage for six million uninsured Californians, a topic stirring intense debate and discussion among politicians, the medical community, businesses, the insurance industry and the general public.

One health care advocate says half the problem can be solved without any new laws or regulations. It can be done very simply, by signing people up for programs under current laws. The question, however, is whether the state’s elected officials, government administrators, and most important, the taxpayers want to provide the billions of dollars needed to pay for a big boost in enrollment.

“California never funded the Medi-Cal program properly,” Phil Lebherz of the Foundation for Health Coverage Education said referring to the state’s version of Medicaid.

“The legislature before Gov. Schwarzenegger did not do a good job on Medi-Cal; they wanted to spend money on other things,” said Lebherz, a veteran of the insurance industry, who created the Foundation for Health Coverage Education to help uninsured people get coverage through existing programs.

Educating People About Their Options

The not-for-profit foundation uses grants from Blue Cross of California and other donors to help people learn about public health insurance programs. Lebherz started the foundation for California consumers and now has expanded it to offer a toll-free number, in which people in all 50 states can call and find out what programs they might be eligible for. There have been more than 10,000 calls for information in California in the past year.

Of the 6.7 million uninsured people in California, 2.9 million are immediately eligible but not enrolled in public programs that would provide them with health coverage, according to an analysis of Census Bureau data by the Blue Cross Blue Shield Association, cited on the foundation Web site.

The Web site notes that a family of four can have an income up to $50,000 a year and still qualify for state-subsidized insurance coverage at a monthly cost to the family as low as $4 per child. The rest of the insurance coverage premium is paid by the state of California under the Healthy Families program, California’s version of the State Children’s Health Insurance Program, which is coming up for renewal this year in Congress.

A Different Way To Look at the Uninsured

Lebherz’s Web site offers a different definition of the uninsured from the one most often cited in the press: that there are 46 million people without a health coverage policy.

The way Lebherz sees it, these people do have coverage — they simply haven’t officially been enrolled. According to the Congressional Budget Office, “Some people who report being uninsured may be eligible for public programs … and receive retroactive coverage … and should therefore be viewed as insured.”

The figures for Californians who are uninsured include:

  • 2.9 million who are eligible today for existing programs;
  • 2.2 million in families with incomes of more than $50,000 a year, many of whom presumably could afford to buy a policy;
  • 652,000 temporarily without coverage as they move between jobs; and
  • 938,000 long-term uninsured, many of whom are unable to afford coverage in the individual market and don’t have access to employer-sponsored insurance.

From Lebherz’ viewpoint, half the problem could be eliminated if the state were willing to pay for programs already on the books. It’s not so much a question of building new structures as it is willingness to pour money into existing programs. But California, like other states, is nervous about the growing tab for Medi-Cal, which now equals state expenditures for education from kindergarten through high school.

A Selection of Public Programs

The foundation’s Web site offers a matrix with the details of a variety of public programs, showing who can apply for the programs and the income restrictions.

For example, low-income pregnant women and infants up to a year old are covered under Medi-Cal through the Access for Infants & Mothers. There is no charge for the program.

Healthy Families offers health, dental vision and drug plans at a monthly cost of $4 to $9 per child depending on the insurance policy the family selects. The maximum monthly payment is $27 per family, with just a $5 copay for office visits. Coverage is available for families with incomes up to 250% of the federal poverty level, or about $4,303 per month for a family of four.

Undocumented immigrants can get help through restricted Medi-Cal coverage. The coverage includes emergency services, pregnancy-related care, including pre-natal and delivery, kidney dialysis and treatment for breast and cervical cancer. Family eligibility extends to people with monthly incomes up to 200% of the poverty level. The program is free.

For people who haven’t been able to buy insurance because of a medical condition, the state offers the Major Risk Medical Insurance Program. It includes coverage for 36 months. After that, there is guaranteed coverage with a commercial company. Costs for the 36-month coverage vary, but there is a $2,500 limit on out-of-pocket spending in a year by the subscribers.

Forecast for Funding Is Unclear

At this point, no one knows what kind of funding governments will come up with to deal with the uninsured. There is a growing dispute between President Bush and the Democratic majorities in the House and Senate about funding for SCHIP, and the president has called for cost-control efforts in Medicaid and Medicare, as well.

Similar debates are playing out in state Legislatures nationwide.

“We need more financing, more money in the system” to expand the numbers of people in all these programs, said Lebherz. He is waiting eagerly to see if the governor, the legislature and the federal government will come up with the cash to care for the uninsured.

Related Topics

Health Care Costs Insight Insurance Medi-Cal