From healthy kids to healthy adults
Experts say medical insurance is investment
Jamel Bomer of Redford Township, a Westin Book Cadillac valet, is the father of a 1-year-old on Medicaid.
"He can go to any doctor that accepts it," Bomer said of son Ryan. "Without it, we wouldn't be able to provide him care."
Even with publicly funded Medicaid, which many doctors don't take, Bomer and his fiancée are working off a $230 bill for the part of Ryan's birth that wasn't covered on Bomer's $5.15 per hour plus tips. "Our income is tight to the penny."
Although Ryan is covered, neither Bomer nor his fiancée, a TV news intern, have insurance.
While Congress and the president debate over comprehensive health care reform, local and national experts say making sure all children have coverage now will mean they have a better chance of growing into healthy adults who will be less of a burden on the health care system.
There are 7.3 million uninsured children in the country, about 151,000 of them in Michigan, and many more children who are underinsured. Their health care coverage may not meet all their needs.
Uninsured, underinsured kids need health solution
Beth Hurley of Canton has relied on public and private health insurance to care for her two sons with serious health problems. The Hurleys have employer-based coverage now, but to lose it would bankrupt her family.
"Financially, it would ruin us," said Hurley, whose 7-year-old son has severe asthma and whose 10-year-old son has a skeletal disorder that requires repeated surgeries not completely covered by their current insurance.
She says she believes, like many experts, in universal coverage for all U.S. children, including thousands of uninsured children in Michigan. With it, her children would be covered no matter what her and her husband's job status.
Universal coverage of children is part of health care reform bills in both the House and Senate. HR3200 and a bill from Montana's Democratic Sen. Max Baucus, America's Healthy Future Act of 2009, mandate coverage for everyone including children, with tax penalties for those, including parents, who don't comply.
The bills call for keeping current coverage, whether individual or employer-based, and creating an insurance exchange to purchase private products or to increase enrollment in public insurance programs.
One way experts say universal coverage could happen would be to increase eligibility for public plans such as Medicaid and the State Children's Health Insurance Program, which cover most basic pediatric care, such as routine visits, and most vaccines plus dental, vision and some mental health visits. SCHIP is run in Michigan as MIChild, Medicaid as HealthyKids.
Another option for covering children would be through more affordable private insurance.
"People should have to have coverage just like you have to have car insurance," said Hurley, who is a paid contributor to the Free Press' MomsLikeMe.com site.
Universal coverage is supported by people such as Thomasina Stoudemire, 50, an Oak Park grandmother of five.
"We don't have time to be messing around, saying, 'I have to wait till Friday,' " she said of people who have to wait for paychecks to afford their children's health care.
There are more than 2.5 million children in the country and about 151,000 in the state who have no health coverage, according to the Kaiser Family Foundation, a California-based nonpartisan health research group.
While seeking to insure them, another issue is improving coverage for underinsured children -- those with policies that don't cover everything they need, such as Hurley's 10-year-old son. That's why the Hurleys had to buy an extra policy, about $50 per month, to cover more of the nearly $50,000 in spine surgery he needs every four months.
Cost-effective coverage
Universal coverage proponents say children are less expensive to insure -- about $1,500 a year compared with $5,000 for adults -- so a rough estimate of insuring the 151,000 uninsured children in Michigan would be around $226 million per year, versus about $4.6 billion for the 920,000 uninsured Michigan adults.
"Children don't get sick very often. You're paying for preventive care and unexplained, but mild illnesses," said Matthew Davis, University of Michigan pediatrician and public policy expert.
In the long run, the benefits are huge, proponents say.
Children with access to health care do better in school because they're not missing class because of illness -- and stand a better chance of avoiding some chronic illnesses and being healthy adults, said Dr. Stephen Berman, a child health policy expert and University of Colorado School of Medicine pediatrician.
How to do it?
But just how to feasibly insure all children is at the heart of the debate.
There are several possibilities for making sure the United States' young people -- those with no insurance and those with a limited form -- are fully covered, said Berman.
Most lawmakers say they believe children should be covered, but they don't always agree on whether it should come through increased public programs or more affordable private policies.
A spokesman for Michigan Democratic Sen. Carl Levin said he supports universal coverage for children and that Levin previously has supported efforts to increase public insurance programs for children.
U.S. Rep. John Dingell, D-Mich., is the primary author of HR3200 and also supports universal coverage for children, along with adults.
There are multiple ways to achieve this.
One is to increase the income limit for families to qualify for MIChild. Currently, the income limit for enrollment is between $40,793 and $44,100 per year for a family of four -- about double the federal poverty limit. Increasing the limit to between $60,000 and $66,000 for a family of four -- or three times the federal poverty limit -- would effectively insure most uninsured children, who are not always the poorest children, said Bruce Lesley, president of the Washington, D.C.-based family advocacy group First Focus.
Another option would be to resurrect a 2001 bill for a new national children's insurance program called MediKids. Every child would be enrolled at birth, and if private or other public coverage was lost, MediKids automatically would kick in, Berman said.
A third option would create one comprehensive national insurance system for children regardless of parental income. It would be like Medicare for people 65 and older but for children up to age 21, costing about $134 billion, said Berman.
Out of luck at age 18
A higher age cap is something Elizabeth Hodges said she wishes she had for her 19-year-old son, who became ineligible for her Beaumont Hospital employer insurance at age 18. Hodges and Deonte Smith are staring down a $5,000 bill for a lanced boil that would have been a small fraction of that cost under her plan.
But each possible option has its drawbacks.
For instance, there is no mandate that doctors must accept patients in public programs, so parents would have to shop around for doctors who would, said Wayne State University health policy lawyer Lance Gable.
That is the problem facing Tanisha Smith, 21, whose 6-year-old Cortez is on Medicaid. A recent earache went untreated because the Royal Oak mother couldn't get an appointment with a Medicaid provider.
Opponents of health care reform say public programs impede the private insurance trade. So, the concern is that parents would leave their private insurance programs in favor of a public option, reducing competition.
Yet many public insurance plans are mixes of private and public funds. Private insurers, such as Blue Cross Blue Shield of Michigan, administer MIChild and Medicaid with the help of federal and state money.
Davis said there are merits to all the options, but the one that likely would work best for parents and policy makers may not work best for doctors. So, while a MediKids-like program would create a good safety net, it might be a challenge to get doctors to participate.