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Better than an apple a day


SMALL CHANGES, as any parent knows, can make a big difference in the lives of young children.

When Sheila Miguel, a single mother in Sun Valley, had no health insurance, her 7-year-old daughter, Chelsea, received only sporadic treatment for her asthma, usually in an emergency room after she suffered an attack. Chelsea almost never saw the same doctor twice. When her medication ran out, the family often could obtain more only by returning to the emergency room. Mostly, Sheila tried to make do on her own.

"She would have asthma attacks and I would just treat it at home,

But since last winter, Chelsea has received health insurance through the "Healthy Kids" plan offered by the Children's Health Initiative of Los Angeles, a public-private partnership that covers about 40,000 otherwise uninsured children across the county.

Chelsea, a second-grader, now receives regular treatment from a doctor in a mobile asthma clinic that visits the small, welcoming health center attached to the Charles MacLay Middle School in Pacoima. She misses school much less often and plays more easily with her friends when she's there. And her mother sleeps better at night.

In addition to Los Angeles, 23 other counties across California have launched similar partnerships to cover children who don't receive insurance through their parents' employers or qualify for existing public programs. These innovative county programs, which cobble together public and foundation dollars, can't provide a long-term solution for uninsured children because they lack a sufficiently stable funding source. (The L.A. initiative currently has only enough money to cover its caseload through, at most, December.)

But their efforts, through the experiences of children such as Chelsea, are demonstrating the benefits the nation could see from a sustained drive to insure more kids.

Until recently, children had been the exception in an otherwise bleak healthcare story of rising costs and declining access. From 1998 through 2004, the number of children without health insurance across the country dropped to 7.9 million, from 11.1 million, according to the Census Bureau. That was largely because of the Children's Health Insurance Program, a state-federal partnership created by President Clinton and the Republican Congress in 1997 to subsidize insurance for children in working-poor families.

Through President Bush's first term, the growth in CHIPs (and Medicaid, another state-federal partnership that insures the poorest children) offset a decline in children receiving coverage through their parents at work. But with healthcare costs pressing their budgets, states squeezed services, and the number of children receiving insurance through the government dropped last year. And because employer-based coverage for kids continued to erode, the number of uninsured kids rose again. More than 8.3 million children now lack health insurance.

That number is a stain on the nation. Recently, the Congressional Budget Office calculated that, because of medical inflation, Washington would need to increase CHIPs funding by $13.4 billion over the next five years just to maintain its existing caseload. But in his latest budget, Bush proposed spending only about $6.3 billion. That's like a parent offering to buy a child one new pair of shoes all the way through high school.

Congress is moving to set a higher standard. House and Senate Democrats have approved budgets providing up to $50 billion in increased CHIPs funding over the next five years. Before Democrats can commit those funds, they must find offsetting revenues or cuts in other programs, a formidable challenge. But if Democrats meet their $50-billion goal, they will provide CHIPs with enough money to cover not only the current caseload but as many as two-thirds of the nation's remaining uninsured children.

The county initiatives underway in California show what that investment could buy for the rest of the nation. One analysis of the program in Santa Clara County, which pioneered the statewide effort, found that it has increased the number of children receiving preventive care, reduced the number reporting poor health and cut health-related absences at school.

Those findings wouldn't surprise parents like Sheila Miguel or Milagro Villalta of Sun Valley. Villalta's 7-year-old daughter, Kelly, who also suffers from asthma, was recently enrolled along with her younger sister in California's CHIPs program by a counselor at the MacLay clinic. With insurance has come care that has changed the family's life.

"We're not as worried," Villalta said. "We rest more; they rest more. It is very different."

Millions of other strapped American parents might say the same thing if Washington makes the right decisions in the months ahead.

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