OLYMPIA – Starting Sunday, any family of four in Washington living on $51,625 or less a year will qualify for cheap, or free, state-subsidized health insurance for their kids.
“The governor’s goal is to get all kids covered by 2010,” said Jim Stevenson, a spokesman for the state Department of Social and Health Services. “This is a big step toward that.”
Until now, some categories of children, including illegal immigrants and recent legal immigrants, couldn’t qualify for state coverage if they were above the federal poverty level: $20,650 for a family of four.
But state lawmakers this spring, in a bill sponsored by Spokane Democratic Sen. Chris Marr, agreed to pay to cover all kids in families earning up to 21/2 times the federal poverty level. The state plan includes medical, dental and vision benefits.
Many families will pay nothing. Those earning above roughly $41,000 will pay $15 a month per child, up to a maximum of $45 per family.
“We’re raising a generation of kids whose understanding of a health-care point of access is a hospital emergency room,” Marr said Wednesday.
Preventive care is far cheaper, he said. And uninsured patients cost everyone more, he said, including the insured patients who end up paying more as health providers try to balance their bottom line.
“We’re already picking up the cost,” he said. “This, if nothing else, is a very practical approach.”
As for the illegal immigrant children, he said, he feels it’s wrong to deny children health coverage on the basis of decisions their parents made.
The state’s expecting 45,000 more children to sign up over the next two years, at a cost of about $61 million.
A small percentage of those – Marr guesses about 5 percent – will be immigrants. The rest, state officials say, will be children whose parents don’t realize that their kids already qualify for the coverage. In Spokane County, the median household income last year was $43,385.
“Many people don’t know about” the state program, said Cassie Sauer, spokeswoman for the Washington State Hospital Association.
Moderate-income families often wrongly think that their income disqualifies them.
So the state and advocacy groups are boosting their outreach programs. There are believed to be 70,000 to 80,000 children in the state with no health insurance, Stevenson said.
Between the eligibility changes and getting people who already qualify to apply, the state hopes to cut that by more than half.
By 2009, the limit for subsidized coverage will rise to three times poverty level, or nearly $62,000 for a family of four. And families making more than that would be eligible to buy into the plan if they pay the state’s full cost, currently about $170 a month.
Nonetheless, physicians and Marr himself caution that the Medicaid-based rates paid by the program must increase. Otherwise doctors won’t be able to afford to see the kids.
“It’s a great thing, I’m glad they’re getting covered, but coverage does not mean access,” said Dr. Deb Harper, a Group Health pediatrician in Spokane who is also vice president of the state medical association.
“Many if not most of physicians are forced to limit the number of (Medicaid) patients that they see. If they don’t, their practice is belly-up in three to six months.”
Trying to help, lawmakers this spring agreed to spend millions of dollars more in additional payments to pediatricians and other doctors who treat children covered by Medicaid. But that badly needed increase has been delayed by months, Harper said.
“It is a concern,” Sauer said of the payment rates. “We don’t want these kids to just have an insurance card and no place to go.”
Parents can get an application for the program at local Department of Social and Health Services community services offices or by calling (877) 543-7669, a toll-free hotline.