Unprotected Innocents

Los Angeles County has the most and biggest of many things, including, unfortunately, uninsured families. The county supervisors are trying to do more with their limited health care money, and as part of that effort they voted last week to rebuild County-USC Medical Center as a smaller facility and to shift as many patients as possible to community-based clinics.

Success ultimately rides on reducing the whopping number of people in the county who lack health insurance, even federally funded Medi-Cal; the figure is estimated at 2.7 million. Without significant federal or state help, the county is obligated to provide varying levels of care to these residents.

A recent Census Bureau survey, however, does not bode well for efforts to reduce the rolls of the uninsured. It shows that, because of federal welfare reform, as many as 1 million children nationally may have lost their Medicaid insurance in the last year, and very few are gaining private insurance. The losses will hit especially hard in Los Angeles and Orange counties, whose rates of uninsured children (25% and 19% respectively) are far higher than the national average of 12%.

When Congress passed welfare reform last year, it never intended to strip children of health insurance. Instead it required states to provide coverage to children who would have been eligible under the old welfare laws. Congress and the Clinton administration also made available $24 billion last October to help states cover even more uninsured children.

Children are apparently being swept off insurance rolls anyway because of poor implementation in the states. Here’s what California can do to mitigate the problem:

* See that health insurance is retained by children whose parents’ welfare status changes. Currently, California kids can lose their health insurance if their parents fail to visit welfare offices and fill out extensive forms when they are moved from Aid to Families with Dependent Children (“old welfare”) to the new Temporary Assistance for Needy Families. The state Department of Health Services should automatically re-enroll such children and allow their parents to submit forms by mail.

* Expand Healthy Families, the state’s new health insurance program for low-income children. California, with the largest population of uninsured children in the country, 1.3 million, is eligible to receive nearly $855 million in federal funds every year. Gov. Pete Wilson and the state Legislature, however, decided to decline nearly $500 million of it to avoid having to pay matching funds.

Next year, the state should bid for the full amount and use the additional funds to reduce the state’s current requirement that working poor families pay $27 per month for the insurance coverage, a significant disincentive for some. The additional funds should also be used to extend coverage to children whose families fall below 300% of the poverty line--the current cutoff is 200%, which amounts to an income of $32,000 for a family of four.

Los Angeles County faces a public health challenge unlike that of any other American region. Only with the active help of Sacramento and Washington can it succeed.