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America's Unprotected Kids

Parents, policy-makers and health care providers search for a cure for one of our worst epidemics: uninsured children.


Doctors told Garry and Carla Rapala that their daughter, April Rose, would not live to see her second birthday.

Born with severe disabilities, April has fought a constant battle for her health.

"Sometimes it’s touch and go," says Carla. "We never know if we’ll end up taking her to the hospital."

Now age 10, the family calls April their "miracle baby."

But miracles don’t come cheap.

While Garry’s health insurance as a forest ranger with the Wisconsin Department of Natural Resources has covered most of their needs, the family has turned to the federal Supplemental Security Income program for help in paying April’s medical expenses. However, under proposed cuts to SSI, April could be one of 135,000 children to lose coverage.

Chart, Uninsured and Barely Insured

"It would be disastrous if we lose SSI," says Garry, a steward in AFSCME Local 1218 (Council 24), who resides with his family in Tomah, Wis.

"I’m really angry that Congress is trying to balance the budget on the backs of disabled children by gutting the SSI benefit," he says. "Right now, we don’t know if we will be denied benefits in the future. No matter what, we’ve still got to come up with plan B because April is a survivor and so are we."

April’s story is just the latest twist in an ongoing national crisis: Millions of American children cannot get health insurance or are losing part or all of their insurance.

The U.S. Census Bureau reports that in 1995, 9.8 million American children under the age of 18 did not have health insurance — that’s one in seven children.

Sadly, that number is growing.

The Children’s Defense Fund reports that with employers slashing health insurance benefits, 3,000 children are dropped from private health insurance every day. It is projected that if current health care trends continue, by the year 2000 some 12.6 million children will be uninsured.

And that’s just part of the picture.

TOUGH TIMES. Amy Fink, a member of AFSCME Local 3360 (Council 8) worries about children without medical insurance every day. It’s her job.

A social worker in the outpatient division of the Pediatrics Department of MetroHealth Medical Center in Cleveland, Fink has seen many cases where working families are either uninsured or have lost their health coverage. For the most part, employers are dropping health care coverage of children at startling rates, according to a recent Census Bureau report. There are many temporary, part-time or self-employed workers who lack insurance. Then there are cases where parents earn too much money for Medicaid eligibility and too little to purchase private insurance.

In fact, even Medicaid, which was expanded during the late 1980s and early 1990s, has failed to provide for all eligible children because of poor outreach. It is estimated that 3 million additional children could be receiving Medicaid today.

The shrinking pool of public and private medical insurance has made it more difficult for hospital social workers such as Fink to find help for their uninsured clients. And with less money to go around, hospitals are cutting social workers as well. "Social workers in medical facilities are losing their jobs at a time when they are needed the most," says Judith Ross, Fink’s director at MetroHealth.

Helena Farkas, another social worker at MetroHealth, handles cases involving handicapped and chronically ill children. She recalls trying to obtain funding for a young boy suffering with leukemia whose father worked in a machine shop. The shop owner changed insurance and the father was no longer covered because he could not pay the high premium.

The family was also initially eligible for Medicaid. "Ironically, while I got that child enrolled in a special state-run program for the chronically ill, this same child would not be covered for a medical injury such as a broken leg, for an ear infection or any other non-emergency illness," recalls Farkas.

THE AMERICAN DREAM? The children of Nabor Melo also fall between the cracks of Medicaid.

Melo, a maintenance custodian in the Brownsville Independent School System in Texas and a member of AFSCME Local 1766, qualifies for Medicaid but his children do not: Unlike their father, they are not naturalized citizens — because they were born in Mexico.

Clinic after clinic turned the family away when they sought treatment for 5-year-old Mariela and 9-year-old Rogello, two of their seven children.

Melo’s only recourse for medical care has been to purchase over-the-counter remedies from a Mexican pharmacist.

"Every day we count our blessings that our children’s health conditions don’t get any worse," Melo says. "Our relatives, friends and neighbors have helped ... and we don’t know what we’d do without the union lending a helping hand."

Welfare reform will further restrict Medicaid eligibility to noncitizens: It gives states the option of denying non-emergency health coverage to legal immigrants and their children now residing in the United States. It also prevents future immigrants from receiving non-emergency Medicaid benefits for themselves and their noncitizen children for at least five years.

"It’s AFSCME families like the Melos and the Rapalas who would benefit from the expansion of Medicaid to fill in the gaps in insurance coverage. By raising income levels for eligibility, many more families would be able to receive coverage," says AFSCME Pres. Gerald W. McEntee. "Their lack of health coverage precludes them from obtaining basic primary and preventive care that is vital to their children’s healthy development."

FILLING THE GAP. McEntee notes that AFSCME councils and locals in such states as Minnesota, Oregon and Arizona already have been instrumental in expanding their state’s Medicaid program and other plans to protect uninsured children and the working poor.

Since 1992, AFSCME Council 6 Exec. Director Pete Benner — who is also an International vice president — has served on the Minnesota Health Care Commission which has been helpful in obtaining comprehensive health care reform laws to provide quality, affordable and accessible health care, espe-cially for uninsured, low-income and special needs families.

In Oregon, AFSCME Council 75 supported legislation in the early 1990s that established the state’s health plan for low-income families.

And in Arizona, AFSCME members — through a grassroots petition drive — helped pass the Health Arizona Initiative last year. It provides health coverage for 150,000 working families throughout the state.

These and other states are filling the gaps for uninsured children and their parents. Twenty-four states have encouraged public/private partnerships. In the private sector, several organizations currently offer "kids only" insurance coverage to some 250,000 children nationwide.

The White House and Congress have taken notice of the plight of uninsured children: The proposed 1998 federal budget includes $16 billion for the next five years for benefits, including health care for uninsured children.

Although the details of this proposal are still being worked out, the White House is convinced that the government can locate more than half of the 3 million children who are already eligible for Medicaid but not yet enrolled. The administration has estimated that such efforts would find about 1.6 million children.

AFSCME INPUT. AFSCME members can play an important role in the effort to obtain health care for uninsured children by contacting their congressional leaders in support of federal legislation. Among the bills now being considered on Capitol Hill is the Hatch-Kennedy Child Health Insurance and Lower Deficit Act which would provide affordable child health insurance coverage for working families through a federal-state-private partnership.

In a Senate address, Sen. Edward Kennedy (D-Mass.) said, "No family should have to fear that the loss of a job or a hike in their insurance premium will leave their children without health care."

Nabor Melo agrees: "It would take a load off of my chest to know my children could receive the medical treatment they need whenever they need it."

By Venida RaMar Marshall


For working families who find that even the cheapest, barest-bones health insurance policy is beyond their means, it may be possible to get free or low-cost care through government agencies or specialized health institutes. But finding this care often takes many calls and lots of legwork.

Hospitalization — The Hill-Burton Act provides funds for hospital care for those who cannot afford hospitalization. Call (800) 638-0742 to find hospitals in your area that have funds available.

Prescription Medication — The Pharmaceutical Manufacturers Association has information on free prescription drug programs. Some have strict income requirements, others require only a letter stating financial hardship. Your doctor should call (800) PMA-INFO.

Immunization for Children — The U.S. Department of Health and Human Services can refer you to local clinics. Call (800) 232-2522.

Excluded Conditions — Check local teaching hospitals to see if they are conducting any clinical trials for which you might qualify. Doctors can call the National Institutes of Health’s Patient Referral Line at (301) 496-4891 for help in finding any appropriate clinical trials.

Doctors — Local medical societies can supply names of doctors who might volunteer their services at free clinics or through special programs.

Source: Free Health Care, by Matthew Lesko, published by Information USA, Inc., 1995, P.O. Box E, Kensington, Md. 20895; $19.95.


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