DATE: Tuesday, October 21, 1997             TAG: 9710210013

SECTION: LOCAL                   PAGE: B9   EDITION: FINAL 

TYPE: Opinion

SOURCE: BY DEBRA GORDON 

DATELINE: NORFOLK                           LENGTH:   84 lines

VIRGINIA MUST DECIDE HEALTH CARE FOR CHILDREN DESERVES ITS OWN PROGRAM

It's 4 p.m. on a Monday. In the past 2 1/2 hours, Norfolk pediatrician Carolyn Moneymaker has completed five checkups, diagnosed one child with scabies, checked the Ritalin dosage for another and referred still another to a specialty clinic at the hospital.

For all her work at this Norfolk clinic run by Children's Hospital of The King's Daughters, chances are the hospital will collect little, if any, payment. Only two of the 10 kids she's seen today have health insurance.

Moneymaker calls these uninsured families the ``socially fragile,'' perched on the edge of the health-care cliff. Although many she sees in the clinic may appear healthy, one bad asthma attack, one sickle-cell crisis, could send the entire family into a chasm of debt from which they may not emerge. ``These kids are disasters waiting to happen,'' she says.

That should change next year. New federal money, approved under this summer's Balanced Budget Act, would provide health insurance to nearly half the state's 214,000 uninsured children. Under the act, Virginia is eligible for up to $71 million a year for the next five years to cover kids who don't qualify for Medicaid and whose families are at 200 percent or less of the federal poverty level, about $31,000 for a family of four.

Now it's up to Virginia to decide how to use that money: expand the Medicaid program or create a new children's health insurance program.

A legislative committee studying the issue recommends that the state expand the existing Medicaid program. With an infrastructure already in place, says a subcommittee of the Joint Commission on Health Care, the program could be up and running quicker, with fewer bureaucratic hassles, while still leaving the option open to create a separate program later.

Kudos to Virginia, says Families USA, a Washington-based health policy organization, which would like to see all states expand their Medicaid systems rather than create new programs.

But there are compelling reasons to consider the alternative of a separate program.

Already, 82,000 kids in Virginia are eligible for Medicaid who aren't on the program. One reason is that it's not easy to sign up. You have to go to a Social Services office, fill out lots of forms, verify your income and assets. If you're working, you need to take most of a day off, find transportation, get a baby sitter for your other kids.

It needn't be so difficult. Only about 25 states require on-site application for Medicaid. Most allow mail-in applications, and the National Governor's Assocation is pushing for a streamlined Medicaid application process. But even if Medicaid can be improved, objections remain.

Medicaid is an entitlement program, inextricably linked to welfare. The stigma of welfare is anathema to many working families. They might forgo the insurance to maintain their pride.

A separate program could also, unlike Medicaid, charge a nominal premium to some recipients, further distancing it from the entitlement taint.

According to the state, Medicaid benefits are more expensive than benefits available under commercial insurance policies. A separate program would offer the flexibility to provide less costly - although still comprehensive - benefits.

In many parts of the state, particularly the rural areas, it's hard to find doctors who accept Medicaid's notoriously low payments.

For these reasons, Virginia should create a separate children's health insurance program. Officials at Children's Hospital and the Planning Council say they already have a model in place: Karing for Kids. It offers primary health services to more than 300 uninsured Chesapeake and Norfolk children through a partnership between local hospitals, the public health departments and the Planning Council with support from Trigon.

``They have insurance just like anyone else,'' says Richard Knox, senior vice president at Children's Hospital.

Virginia should also build into any children's health plan - even a Medicaid expansion, if that's the route it chooses - an extensive outreach program. In California, where a new children's health insurance program was approved last month, the state will provide information through the schools and contract with churches and other community organizations to reach eligible families. In New York, the children's health insurance program puts advertisements on milk cartons and is trying to persuade drugstores to tuck inserts into prescriptions, theaters to advertise before movies and educators to hold enrollment nights in school gyms.

The subcommittee studying Virginia's options says it could take until January 1999 or later to get a separate program under way, whereas a Medicaid expansion could begin enrolling kids in July. But an additional six months isn't that much longer to wait if a separate program would be more effective and benefit more children. MEMO: Debra Gordon covers health-care issues for The Virginian-Pilot.

Send Suggestions or Comments to webmaster@scholar.lib.vt.edu