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California and the West

Legislature Moving to Fix Public Health Plans

Services: Report showing that 7 million Californians are uninsured motivates lawmakers. Radical changes are proposed.


SACRAMENTO — An explosion in the number of Californians who lack medical insurance has created strong momentum in the Legislature for reshaping public health programs to remove the stigma of welfare and eliminate the nettlesome paperwork that discourages participation.

Shocked by new reports showing that 7 million Californians, including 1.7 million children, lack insurance, lawmakers are proposing radical changes in public health programs.

These include changes to Medi-Cal, which provides medical care for the poor; the Healthy Families program, which offers subsidized insurance for children of the working poor, and Access for Infants and Mother, which provides coverage for perinatal and infant care.

The issue has such a high priority that the leaders of both houses--Assembly Speaker Antonio Villaraigosa (D-Los Angeles) and Senate President Pro Tem John Burton (D-San Francisco)--have each proposed bills to overhaul the programs.

And on Friday an Assembly budget panel meeting in Los Angeles pledged to focus most of its energies on expanding health care for the uninsured.

"It's an idea whose time has come," said Steve Thompson, a lobbyist for the California Medical Assn., the state's largest and most influential doctors organization.

Villaraigosa's approach calls for the consolidation of Medi-Cal, Healthy Families and AIM into a single program, allowing recipients easy one-stop shopping for government-assisted health care, and an expansion of the Healthy Families program.

Burton's plan would make Medi-Cal more accessible by allowing the poor to submit health insurance applications by mail, reducing the amount of documentation required to qualify for benefits and eliminating requirements that recipients must requalify for the program every three months.

"The biggest health care issue facing California, make no mistake about it, is access to care," Villaraigosa said. "Every month there are 50,000 [more people going uninsured]. . . . We've got to do something about health care."

The urgency associated with changing the programs stems, he said, from disturbing statistical evidence.

The numbers show that many of the uninsured could qualify either for Medi-Cal or Healthy Families, but they have not enrolled in the programs. Burton notes that at least 1.1 million uninsured children are eligible for either Medi-Cal or Healthy Families.

Families do not apply for these programs, advocates for the poor say, because of the mounds of government rules and regulations attached to them.

"For years we have been trying to save money by making it more difficult for people to access these programs," said Sen. Kevin Murray (D-Los Angeles), who is the author of a bill similar to Villaraigosa's and backed by the CMA. "The system seems to have been designed with the assumption that people are going to be fraudulent."

Families trying to wend their way through the Medi-Cal system have to cope with a maze of eligibility differences.

Families can find themselves in the predicament of having some children qualify for Medi-Cal while others in the family must obtain health care through Healthy Families, a government-subsidized insurance program that requires a premium payment and covers the working poor who are not eligible for Medi-Cal.

"Just the idea that they would have to treat their children differently is agonizing to many families," said Lucy Quacinella, staff attorney for the National Center for Youth Law.

Both Villaraigosa's legislation and Burton's would attempt to remove the stigma of welfare by eliminating any requirement that applications for health care insurance be made at welfare offices.

"If I've told anything to folks in my [Democratic] caucus, it is, 'Don't buy this dysfunctional model of these immigrants. They're just like your grandpa. They came here to work to get ahead,' " Villaraigosa said.

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