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Illinois Health Care Plan for Kids is `Long Overdue'

Posted on: Wednesday, 29 March 2006, 00:00 CST

By MARA LEE, Courier & Press Washington bureau (202) 408-2705 or leem@shns.com

In July, Illinois will become the first state in the nation to offer health insurance to every child within its borders.

For years, states have been trying to get more children covered by expanding Medicaid, under different program names, to poor families but whose incomes exceed state or federal poverty levels.

In Indiana, such a program is called Hoosier Healthwise, and it covers more than 10,000 children in Vanderburgh County.

Illinois is taking it a step further. By charging premiums on a sliding scale, it plans to offer insurance to all children, even those of middle class families who don't have their kids covered. The expanded program is called All Kids.

"It's frankly long overdue. Every single child ought to have health insurance," Illinois Gov. Rod Blagojevich said at a recent Washington news conference. "In America today, there are nearly 9 million children who don't have health insurance, in this land of opportunity."

Among them are Kyley and Tyler Cushman of Carmi, Ill. Sandra, their mother, used to cover them on her employer's plan when she worked as an activity director at an Evansville nursing home. But when she started working at a Carmi nursing home last June, she took a big pay cut.

At her new job, to cover her sons, 14 and 10, her monthly premiums would have been almost $400 a month. Her husband, an electronics technician, also has insurance from his employer. It would have been more than $300 a month if his plan had covered their kids.

So far, paying cash for their medical expenses has worked out. Her younger son had an earache this summer and they paid a little more than $100 for the office visit and antibiotics. They paid $145 for their older son's physical, required for enrolling in high school.

Her younger son has Perthes disease, a hip development problem, but The Shriners Hospital in St. Louis has provided free treatment over the years for that condition. He no longer needs leg braces to walk.

But it would be a major relief to have the boys covered again. "You never know when something happens," Cushman said. The Cushmans will pay $140 a month in premiums for All Kids.

In White, Edwards and Wabash counties, more than 2,600 children were covered by KidCare, the expanded Medicaid program, in 2003. The state estimates there are about 275 uninsured children in Wabash, about 300 in White, and about 165 in Edwards County. That's about 8 percent of the children in the first two counties and almost 10 percent of the children in Edwards County.

Kathleen Strand, a spokeswoman for All Kids, said most counties in Illinois fall in the range of 8 percent to 10 percent of the children being uninsured.

She hopes that with these children covered, the state will attract more pediatricians or family practitioners because they won't have to absorb those costs. Rural counties often have trouble retaining pediatricians.

Several health care professionals in Southeast Illinois hope she's right, but they are wary.

That's because the state is not planning any new taxes to cover the cost of the expansion, which it estimates will cost $45 million the first year. Illinois is projecting $9.4 billion in Medicaid spending from last July through the end of June. Less than $2 billion of that is for the children's health care.

Blagojevich said 75 percent of the expansion's costs will be paid by premiums, and switching Medicaid to a primary care case model will more than cover the remaining costs by better treatment and efficiency.

Treasurer Judy Topinka, who is running for governor, is doubtful.

In her campaign literature, she says, "I would not expand programs without knowing true costs and having a reliable funding plan."

She criticized the state's record of reimbursing doctors for Medicaid patients.

"We are damaging access to heath care by delaying payments to heath care providers," she said, adding that it "jeopardizes the financial standing of thousands of health care providers, hospitals and pharmacies."

Jay Purvis, CEO of Wabash General Hospital, said that in Illinois, "payment from Medicaid is sporadic at best. It may not pay for months."

A pediatrician in Southeast Illinois, who didn't want to be quoted because he feared retaliation from state officials, said sometimes his practice wasn't paid for more than a year for services they gave to children covered by Medicaid. Other pediatricians in the area declined to be interviewed.

But if the program is funded, the professionals said it would be wonderful.

"As I view it, it may actually get more kids to primary care," Purvis said.

The challenge now is to enroll kids in the new plan, Blagojevich said.

Cushman only found out about All Kids because she was at the health department office for a work meeting.

The governor also hopes other states follow Illinois' example.

"Today it's hard to imagine how you could live in a country where every child didn't have an opportunity to go to school," he said. He says someday people will look at health care the same way. "I believe providing health care to everyone is an inalienable right."

For more information and to pre-enroll, visit www.allkids covered.com or call (866) -All-KIDS. The state is looking for volunteers to help enroll uninsured kids.

Source: Evansville Courier & Press

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