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County to Insure Poor Children

Health: Officials reserve $100 million in tobacco taxes for care of infants and preschoolers. The services will become available in six months.


Los Angeles County officials have set aside $100 million in tobacco taxes to provide health insurance to babies and preschoolers from low-income families over the next five years, an ambitious effort to cover gaps in other government health care programs.

The Children and Families First Proposition 10 Commission--which administers cigarette tax proceeds created by that initiative--approved the insurance plan Thursday, but said it will take about six months before it becomes available.

"We're making a very big statement about our priorities," said Zev Yaroslavsky, who as chairman of the county Board of Supervisors also heads the commission. When the program is in place, he said, every child under 6 will have access to medical care in Los Angeles.

The program, called Healthy Kids, will provide outpatient, hospital, vision, dental, prescription and mental health coverage for a premium of $4 to $6 a month per child under 6 years of age. There will also be "modest" co-payments for emergency room visits, prescription medication and other non-preventive services. The details of how the plan will be delivered--whether through an HMO or a patchwork of private physicians--have yet to be worked out.

The program will serve a narrow swath of children, primarily those from working poor and undocumented immigrant families who do not qualify for programs such as Medi-Cal or Healthy Families because of their income or legal status. Together, those two federal and state programs help primarily legal residents whose income does not exceed 250% of the federal poverty level, or about $45,000 a year for a family of four.

Healthy Kids will help children whose families earn up to 300% of the federal poverty level, or about $54,000 a year for a family of four. It will accept children regardless of their legal status. The commission estimates that 15,000 county youngsters will qualify.

Officials said they also hope their outreach effort will help enroll children in other government programs. They estimate that 80% of the county's uninsured children under 6 qualify for subsidized health care but have not signed up.

Four other California counties, including San Francisco, have started similar plans.

Health care advocates said they were pleased that the commission will help the very young stay healthy, but they worry about school-age children and adults who can't afford health care.

"You can only bite off a piece at a time, and it's an excellent piece for them to start off with," said Cass Ben-Levi, head of community and government relations for the Community Clinic Assn. of Los Angeles County. "It's just such a small piece, and such a large problem."

She and others expressed concern about the availability of doctors, given the Board of Supervisors' decision last month to close 11 public health clinics, reduce by 25% subsidies to private clinics that treat the uninsured and end inpatient services at High Desert Hospital, an effort to begin to deal with a looming $800-million deficit.

"We need to have a network for kids, and if you close the clinics and close the hospitals, that's not going to happen," Lynn Kersey, of Maternal and Child Health Access, told the commission Thursday.

Last month, actor Rob Reiner, who led the successful campaign to hike cigarette taxes to fund programs for California children, asked the county panel to use some of its roughly $160 million annual allocation to fund health and preschool programs countywide.

On Thursday, Reiner said if the county implements his idea for universal preschool, it would also create an opportunity to sign up those children for health care programs.

The commission, which has the sole authority to spend money allocated to the county for programs that benefit children under 6, approved the preschool idea in theory last month, but is studying how such an ambitious plan would work. Officials expect to vote on a plan in August.

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