All children are entitled to health care...

March 09, 1998|By Penny E. Borenstein

THE scene one evening last fall in a Baltimore hospital emergency room: Room 1 -- a 2-year-old girl, with a fever of 103, has pus oozing from her right ear; she's eaten very little over the past few days. Room 2 -- a 9-month-old boy is turning blue from coughing spasms. Room 3 -- a 15-year-old girl is weak from nausea and vomiting. Room 4 -- an 8-year-old boy is gasping for air, wheezing.

Diagnoses: Room 1 -- untreated ear infection. Room 2 -- whooping cough in an unvaccinated baby. Room 3 -- an unintended pregnancy. Room 4 -- uncontrolled asthma.

Children in rooms 2 and 4 are hospitalized. The patient in Room 3 drops out of school, and seven months later she prematurely gives birth to a baby who must stay in the hospital's neonatal intensive care unit for 27 days. Total bill for these patients: $106,000; that doesn't include the astronomical costs related to the child's long-term disabilities.

In each case, the doctor asks: "Why didn't you take care of this sooner? It could have been prevented." Each parent sheepishly answers, "We don't have insurance." Who picks up the bill? The taxpayers.

This irony is lost on some who argue against the expansion of Medicaid for children of the working poor. They overlook the fact that taxpayers already bear the cost of health care for many such children. The state picks up the bill for much of the hospital-based care for the indigent. Taxpayers also shoulder the cost partly through corporate tax write-offs. Also, the general public pays for it through inflated prices on goods and services provided by hospitals.

But before deciding upon the best method for insuring children, some inaccuracies and misinterpretations appearing in The Sun, the airwaves and in the chambers of the General Assembly must be cleared up.

The governor's plan

Gov. Parris N. Glendening's proposal would expand Medicaid to insure more of the children of the working poor and pregnant women who live in households with incomes up to 200 percent of the federal poverty level.

Despite recent editorials claiming otherwise, nonpregnant adults in the family would not be covered. Incomes included would be about $32,000 for a family of four, $26,600 for a family of three and $21,200 for a family of two. A divorced, working mother with three children earning $30,000 is not "middle class" or "making too much," as stated in recent Sun editorials. Advocates for Children and Youth reports that average living expenses for the basics of living (food, housing, child care, transportation and taxes) in Maryland totals $37,597 for a family of four.

Instead of fully funded coverage, the proposed Republican plan would make families eligible for tax credits in order to help purchase health insurance privately. As described in a recent Kaiser Family Foundation report, any benefit from tax credits would likely be negligible, because low-income earners already pay little in state taxes.

There is a vast difference between the benefits children receive nTC through Medicaid and those available in private health plans. Under Medicaid, quality assurance mechanisms are built in and the focus is on prevention. For example, immunizations are covered without exception, certified providers must test for lead poisoning, hearing and vision problems. Not all private plans offer such care.

As to the concern that employers would drop dependent coverage because of the availability of publicly funded health insurance, there is no strong evidence of that. Employers have been eliminating such coverage over the past decade at alarming rates even in the absence of an alternative. Why not ensure enrollment in a health plan by guaranteeing that it will be paid for and not relying on the coffers of business? There are nearly $300 million in federal funds designated for use by Maryland citizens over the next five years through Medicaid expansion. If we choose not to capture these dollars, some other state will surely thank us.

Those who argue against so-called handouts overlook the benefits they themselves receive. Middle- and upper-class Americans pay very little for the health care of their families; typically, their employers cover the majority of their premiums.

In the third-richest state in the nation, why not use a small portion ($20 million for Medicaid expansion) of the annual state budget to insure health care costs for children in low-income families? I would be proud to have my taxes applied to insuring quality health care for children. The uninsured child has that right, just as much as the kid next door.

Dr. Penny E. Borenstein is the assistant commissioner for child, adolescent and family health, Baltimore City Health Department. She also provides health care to insured and uninsured children in East Baltimore.

Pub Date: 3/09/98

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