In his 2004 budget proposal, Gov. Arnold Schwarzenegger asked the state Legislature, in light of tough fiscal times, to join him in making some difficult choices. He suggested reducing California's $22 billion deficit by capping enrollment in the state's Healthy Families program, which currently provides affordable healthcare to some of California's neediest children. It's a move Angie Nieves doesn't understand.
As a single-income mother of five kids younger than 6, Nieves knows all about tough fiscal times and difficult choices. A few years ago, she and her husband were looking to buy a bigger home; today, after an accident and a stroke that left him permanently disabled, she is losing her struggle to keep her family off public assistance.
A hairdresser, Nieves tried to cover the $400 a month for her children's health insurance with credit cards. But last year her credit ran out and she was forced to choose between paying her mortgage and keeping her children's health coverage. She decided to keep her family's home.
"I have to keep a house for my kids," she says. "I just figured if things come up, I'll just handle them. I know I sound like a horrible mom, but I'm trying very hard."
It's not easy. Two of her children have chronic asthma, and 4-year-old Kassandra suffers from asthma, spina bifida (a debilitating birth defect that impairs the nervous system) and hydrocephalus (an accumulation of fluid in the brain). In the past three months, Nieves has visited a doctor on dozens of occasions-nine separate times in December alone. With thousands of dollars in medical bills and no money to pay them, she says she was considering quitting her job in order to qualify her family for the state's Medi-Cal system. Then she learned about Healthy Families.
Healthy Families, which began in 1998, provides affordable health insurance to an estimated 700,000 children. The program assists families that don't qualify for fully subsidized Medi-Cal coverage but whose annual income falls below 250 percent of the federal poverty line-roughly $69,000 for a family of seven. While the state covers the majority of the healthcare costs, Healthy Families parents still pay reduced monthly premiums and flat fees for prescription drugs and some medical appointments. For Nieves, who has enrolled in the program but has yet to be accepted, it offers the help her family needs while allowing her to maintain to her pride.
"This program actually made it possible for me to work, to try to be a productive part of society, instead of quitting and living off of the system," she says. "I would probably have a much better income if I quit working and lived off welfare, but you can clearly see that it would definitely cost taxpayers a lot more money."
While the Governor's proposal wouldn't kill Healthy Families outright, he has suggested capping the program's capacity at current levels, thereby forcing new families to wait an estimated eight months before gaining coverage.
But Catherine Teare, director of policy for Children Now, says sick children can't afford to wait that long. "A child with asthma can't wait to see a doctor," she says, adding that one way or another, the government will have to pick up the bill: "Somebody has to eventually pay for the healthcare that children get, and while it is harder to show, we eventually end up paying more for the healthcare they don't get."
In Florida, where California's finance director, Donna Arduin, was budget director before being hired by Schwarzenegger, a cap was imposed on a similar program last July and more than 70,000 children are now on a waiting list for coverage. Healthcare advocates from the 100% Campaign, a coalition of nonpartisan advocacy organizations, point out that Florida's population is less than half of California's and expect an estimated 300,000 children who qualify for the program-but are not yet enrolled-to be shut out if the Governor's proposal passes. They estimate 160,000 children would be put on California's waiting list in the first year of the cap.
In San Diego County, an estimated 57,000 children are currently enrolled in Health Families and an additional 28,000 are eligible for the program.
The Governor has also suggested restructuring the Healthy Families program and increasing the premiums families pay. In addition to the $14 or $27 monthly premiums, he would charge families extra for vision and dental coverage, services that are currently covered by the program.
While the Governor claims capping enrolment in Healthy Families would save California $31.5 million, others believe the move may actually end up costing the state in the future. Under the proposal, the cost of creating and maintaining the cap and waiting list would exceed the amount saved this year. Also, because the federal government contributes $2 for every dollar California spends on the program, the Governor may end up sending some $63 million in federal funds back to Washington.
According to Tony Cava, spokesperson for state Secretary of Health and Human Services Kim Belshé, Healthy Families is an important and successful program that neither the secretary nor the Governor want to cap, but the state simply can't afford to cover all of the children who qualify.
"Technically, were not sending money back, we are just not putting any money in," he says. "It's just because we can't afford it at this time. When you have the large budget deficit that we inherited, you have to make these cuts someplace."
But Christen Golden Testa, the director of the California Health Program for the Children's Partnership, points out that the $63 million in federal funding has already been allocated to California's children. Whatever portion of the money California doesn't use will be redistributed to states that can use it.
"It's a huge bang for our buck," she says. "We not only get the federal money into California, but it also keeps our children healthy and in school learning. It really is that pound of prevention."
Healthcare advocates worry that if the Governor's proposal passes, uninsured families on the waiting list may be forced to forgo expensive doctor visits, turning to already-overcrowded emergency rooms for healthcare. It's a prospect the San Diego County Department of Health and community healthcare groups hope to avoid.
"It puts pressure on emergency-department teams, which typically means longer waits," says Steve Escoboza, president and CEO of the Healthcare Association of San Diego and Imperial Counties. He points out that longer waits affect everyone, including the insured.
"People who are uninsured not only live sicker and die younger, they are also one emergency away from financial ruin," says Anthony Wright, executive director of Health Access California. "It makes a lot more sense to insure people and make sure they get the preventative care they need so that they're not in the emergency room stressing a healthcare system that is already very fragile."
In addition to Healthy Families, the Governor has also purposed plans to cap enrollment in two other programs that provide children with healthcare. The California Children's Services (CCS) program pays for doctor visits, hospital stays and surgery for an estimated 37,000 severely or chronically ill children. Schwarzenegger's proposal would cap CCS enrollment at current levels and put roughly 1,500 children on waiting list next year.
Nieves' daughter, Kasssandra, is currently covered under CCS. The program pays for the braces, walker and wheelchair she needs to get around, as well as therapy sessions, doctor visits, medication and her upcoming surgery. Nieves says she can't imagine having to wait for the help her daughter needs.
"It is incredible what they have done for her. I don't know how people would get through without this program," she says. "It just kills me, knowing how difficult it is-it just doesn't make sense. How do you put somebody on hold? You can't put your child's disability on hold."
Schwarzenegger also wants to halt the enrollment of legal immigrants in the Medi-Cal system. By doing so, he would keep an estimated 75,000 legally documented immigrant children, elderly and disabled from obtaining state-funded health insurance in the coming year.
Altogether the Governor's plans have left children's welfare advocates feeling disappointed and misled. Nieves says Schwarzenegger's plans are just cruel.
"All he has to do is put himself in this situation," she says, her voice breaking. "You can't put somebody's child on hold because there is no room. You can't put a child's life on hold and wait to see if they have the space for them. It's not fair and it's not right."
Feelings of disappointment seem understandable considering Schwarzenegger's words on the campaign trail and his political past. During his campaign, Schwarzenegger often touted his impressive record of child advocacy, including the successful passage of the After School Education and Safety Act, which he funded with $1 million of his own money, and his service as head of President's Council on Physical Fitness and Sports under the first President Bush.
Wright notes that during the only debate appearance of his 2003 campaign, candidate Schwarzenegger lauded the Healthy Families and criticized then-Gov. Gray Davis for not enrolling more children in the program.
"We have to make sure that every child in California is insured," candidate Schwarzenegger said in the September debate. "We have a Healthy Family program here in California, and it is a very, very good program. The only problem with the program right now is that only two-thirds of the people that are eligible are not having this health care."
During Davis' tenure, enrollment in Healthy Families increased by about 600,000 children.
Schwarzenegger spokesperson Ashley Snee said the Governor doesn't take these programs lightly and is making difficult choices in a time of fiscal emergency. "For all of these programs, the Governor's goal was to maintain essential services for the state's most vulnerable and at-risk," she says, "while at the same time implement strategies to better manage and control program costs over the long run. These reforms will allow the state to provide essential services to those most in need."
Schwarzenegger's office refused to comment on how that need would be determined or on the waiting list estimates put forth by various advocacy groups.
"It's not leadership to balance a budget by denying children healthcare," says Wright. "He said he was going to use his governorship as a bully pulpit to enroll more children-instead, with these cuts, he is simply being a bully."
While Schwarzenegger pushes his plan in Sacramento, Nieves knows her future holds many more doctors visits. But she hopes to be fully enrolled in Healthy Families before the Legislature makes its final vote on the budget this summer. In the meantime, she asks that politicians consider the financial troubles of families like hers before they attempt to save the state by preventing kids from getting the healthcare that they need.
"We need the help," she says.
After all, these are tough times.