Health Plan Could Add Coverage for 1 Million

SACRAMENTO — The state legislative analyst’s office unveiled a plan Wednesday to provide health insurance to at least 1 million more low-income Californians, comparing its proposal to one scheduled to start in Wisconsin next month.

Landing just as more piecemeal approaches begin to emerge for key votes in the state Legislature, the legislative analyst’s plan would extend state-subsidized coverage to all uninsured families whose income is up to 250% of the federal poverty level--about $41,000 for a family of four.

It also includes provisions to consolidate various government programs and dissuade employers from cutting back existing insurance if their workers qualify for the government coverage.

The legislative analyst contends that the consolidation and streamlining of the application process would save the state so much money that the entire program could cost less than the $200 million Gov. Gray Davis has set aside in his budget for expansion of Healthy Families, the state’s health insurance program for poor children.

“This helps minimize its costs and broadens the coverage at the same time,” said Legislative Analyst Elizabeth Hill.

Although the plan’s comprehensive nature was applauded by health care experts, some of its aspects were less well received.

“What they’ve tried to do is put together a proposal that includes the main features of [pending legislation], but in a more moderate way that might be appealing to the governor,” said E. Richard Brown, director of UCLA’s Center for Health Policy. “The intention was certainly good, but I think they’re missing the boat.”

In particular, Brown singled out the 250% provision, well below the 300% contained in a bill by Assembly Speaker Antonio Villaraigosa (D-Los Angeles). Because better paid employees would pay a higher portion of the premium, the difference in cost to the state would be minimal, Brown said.

“This is insurance, this is not an entitlement program. . . . Eighty percent of these people work and they have to pay into this,” said Villaraigosa, whose pending bill, AB 43, is the most comprehensive of the legislative plans. It would expand Healthy Families and combine it with Medi-Cal and another insurance program for infants and their mothers.

Similarly, the legislative analyst’s proposal would remove the need for poor families to apply for multiple assistance programs. Brown estimated that one in five children who are eligible for Healthy Families has a sibling eligible for Medi-Cal, for instance.

Senate leader John Burton (D-San Francisco) has a bill that would allow families to mail in applications, a provision the legislative analyst adopted in her report. Burton’s bill, SB 780, cleared the Senate and moved to the Assembly on Tuesday.

A red flag some see in the legislative analyst’s report is its suggestion that the Legislature could limit the number of enrollees. Although it is described as a cost control measure, they said it is actually an ill-advised attempt to draw moderate votes.

“It almost defeats the purpose of establishing a program . . . to meet the needs of families who need health insurance,” said Dawn Horner, associate director of the Children’s Partnership, which has joined a campaign with other children’s organizations to advocate that all children be provided health insurance through public and private sources.

And, others said, a cap may not be possible anyway.

The proposal would require federal approval because it, like some of the Legislature’s efforts, relies on a more creative use of federal Medicaid funding--distributed as Medi-Cal in California.

When Wisconsin tried for a similar cap last year, its application was denied. Wisconsin’s BadgerCare program--named for the state animal--is set to begin July 1. An estimated 23,000 additional children and 27,000 parents will be covered.

BadgerCare resembles the legislative analyst’s proposal in its sliding scale for families to help pay premiums. In the example given by the legislative analyst, a family might pay $80 a month, which some health care advocates deemed far too high.

A key difference between the two states, however, is that 17% of Wisconsin’s working low-income parents lack health insurance, while estimates in California range up to 40%.