Legislature 2004
Health-care fee for poor kids causes split

By Rebecca Cook
The Associated Press

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OLYMPIA — Many Washington residents easily part with $5 a day at their local coffee shop.

For others, $5 means they'll be able to buy groceries, pay the electricity bill, or get school supplies for their children.

In the next 10 days, legislators will decide whether poor families can afford $5 a month in Medicaid premiums for their kids. Both sides of the debate agree it's a question of responsibility.

Republicans say poor families should take responsibility for paying at least something for their children's health care. But Democrats say premiums will force families to drop out of Medicaid. They argue the state should take responsibility for making sure poor kids get health care.

Annette Hensley, 43, says that if the Legislature imposes premiums she will do whatever it takes to pay them and keep her 14-year-old on Medicaid.

"It would put a big strain on us," said Hensley, whose family income is about $25,000 a year. "Something would have to go. I don't have cable, so probably the Internet. Maybe my cellphone."

From her work at the Spokane Health Improvement Partnership office, where she helps poor families sign up for state services, Hensley says she knows many parents can't afford premiums, no matter how small.

"Some people just have no options," she said. "There will be quite a bit of people dropping off, and that's sad because they'll end up in the emergency rooms."

The budget of the Republican-controlled Senate proposes premiums between $5 and $15 a child, with a cap at two children so no family would pay more than $10 a month on the low end and $30 on the high end. The plan would impose premiums on 165,000 children whose families currently pay nothing for Medicaid. The Senate actually decreases the premium amounts that were set in last year's budget but never implemented.
 
The budget from the Democrat-controlled House eliminates premiums entirely for Medicaid families with incomes less than twice the poverty level. The poverty level for a family of four is $18,850. Democrats point to studies predicting that tens of thousands of children could lose health insurance because their parents wouldn't be able to afford Medicaid premiums.

When they passed their budget last week, Senate Republicans defeated an amendment that would have eliminated the premiums. Going to the House budget plan would add $6.5 million to the Senate budget.

Sen. Joe Zarelli, R-Ridgefield, the Senate's chief budget writer, says taxpayers can't afford to give Medicaid families a free ride.

He noted that premiums wouldn't cost more than 1 percent of Medicaid families' income. He and other Republicans said they believe parents will be able to pay.

"Just because people are poor does not mean they are stupid," Sen. Linda Parlette, R-Wenatchee, said on the Senate floor. "I am sure they will choose to have their children covered by health care and pay that premium rather than having a Big Mac at McDonald's."

Her comments prompted an "oooh" of disapproval from the Democratic side of the Senate.

"Five dollars to a poor family is like $100 or $500," said Sen. Rosa Franklin, D-Tacoma. "It is not that they do not care for their children; it is simply that they do not have the money."

Medicaid enrollments have decreased in other states that have imposed premiums. In Maryland, families with incomes between 185 and 200 percent of the poverty level pay $37.50 a month for their kids' Medicaid coverage. According to Nelson Sabatini, director of the state's Department of Health and Mental Hygiene, enrollment dropped by about 25 percent after the premiums started.

The problem with premiums isn't just the expense, it's the hassle, said Jon Gould, deputy director of the Children's Alliance, a statewide child-advocacy organization. The state Department of Social and Health Service does most business by mail. Many poor families lack checking accounts and would have to pay by money order each month. There are no credit-card payments, online bill-paying or direct-withdrawal plans.

Washington hospitals also are fighting the premium proposal.

Dr. Richard Molteni, vice president and medical director of Children's Hospital & Regional Medical Center in Seattle, says paying for children's health care is a smart investment.

He says premiums would force families to drop off Medicaid and that many of those uninsured children would go to Children's with untreated problems. The hospital would take care of those children, even if their families couldn't pay, Molteni said — but it would strain the hospital's resources and eventually hurt everyone who uses the health-care system.

Copyright © 2004 The Seattle Times Company