Insuring Kids in Indiana
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SUSAN DENTZER: In the category of harried parent, few Americans have anything on Reginald Roberson of Gary, Indiana.
REGINALD ROBERSON: I get up sometimes like between 6:00, 6:30 in the morning, you know, get their breakfast done.
SUSAN DENTZER: Roberson is a single father who juggles caring for his children, Renee and R.J.
REGINALD ROBERSON: I load them up for school. If there’s any medical attention or appointments or anything I need to call and make for the kids, I get that done. The time goes pretty fast, so then it’s almost like 2:00, time for me to go pick him up first. Then I pick her up from school so I can go right in to work.
SUSAN DENTZER: Roberson just started a new job working about 40 hours a week in a restaurant near his home. Unlike his former jobs, this one comes with health insurance. But the coverage is expensive, and Roberson can afford it only for himself. That would leave his kids uninsured.
REGINALD ROBERSON: You know, when they get sick, I have to go, like, to the local Walgreen’s drugstore or something and just “over the counter” it and try to get them well.
SUSAN DENTZER: Now a two-year-old Indiana program is helping Roberson obtain health insurance for his kids. Aimed at children from low- and moderate-income families, it’s called Hoosier Healthwise.
LISA SALARY: I spoke with DCFS And…
SUSAN DENTZER: Lisa Salary is a Hoosier Healthwise outreach worker and a key soldier in the highly successful program. Her job is to find eligible families and help them apply for benefits. To speed up enrollment, Salary’s been equipped with high-tech tools, like a laptop computer and cellular phone.
LISA SALARY: Excuse me, ladies, can I talk to you for a second about Hoosier Healthwise? Do you have health insurance…
SUSAN DENTZER: Salary tracks down prospective enrollees at shopping malls, daycare centers, church services, or any other place she thinks she can find them.
LISA SALARY: She can call that number. I can come out to her, or she can come to me. We can enroll her on that day and get her insurance, okay, right away.
SUSAN DENTZER: Hoosier Healthwise came about because of the creation in 1997 of the joint federal and state Children’s Health Insurance Program, or CHIP. Proposed by President Clinton and later enacted by Congress, CHIP offered the states $24 billion in federal grants over a five-year period. All 50 states, including Indiana, now have their own CHIP programs. That’s resulted in more than two million children receiving coverage in the past two years. And of all the states, Indiana’s CHIP program grew fastest from 1998 to 1999. Indiana’s Democratic governor, Frank O’Bannon, wants all of Indiana’s uninsured children covered.
GOV. FRANK O’BANNON, (D) Indiana: Well, you know, I came in as governor and we started looking at early childhood development, and it told us all, this is the basis to build on. If we’re going to have a better education system, the child has to be healthy, it has to be stimulated, it has to be loved. So it’s the basis. Everything else comes off that– a good education, a good job, a good family, a good community.
SUSAN DENTZER: With an infusion of state and newly available federal dollars, Indiana developed a two-step plan. First, it expanded its existing Medicaid program so that it covered children in families earning up to 150% of the federal poverty level. That means a family of four earning $25,600 a year. Then, just last January, it added a separate package of healthcoverage for children from moderate-income families, earning as much as $34,000 for a family of four. Families in the first part of the program pay nothing for the coverage. Families in the second part pay modest monthly premiums and some low co-payments.
AD SPOKESPERSON: All children deserve good healthcare. But what about the children who don’t have medical and dental care because their parents can’t afford it? That’s why the state expanded Hoosier Healthwise, the healthcare coverage program for children 18 years of age and younger.
SUSAN DENTZER: Nancy Cobb, Indiana’s CHIP program director, says in order to reach all eligible children, the stigma surrounding public health insurance programs had to be eliminated. That attitude is a carryover from the days when these programs were tied to welfare.
NANCY COBB, CHIP Program Director: It’s very important to eliminate the stigma of welfare and of considering health insurance welfare, because families who are working are very proud of what they are doing. And while they want to provide health care for their children, they don’t want to feel like this is public assistance. We want to invite them into the system and be sure that they get the treatment they need and with the respect that they need.
SUSAN DENTZER: That’s why the state replaced the old Medicaid cards with new ones that look like those issued for private health insurance. Then it named the whole program Hoosier Healthwise. It also launched an outreach effort to alert as many families as possible about the newly available coverage.
SPOKESPERSON: I need to ask you a few questions about your application.
SUSAN DENTZER: The state then created simple procedures for enrolling in the program, including one-page applications instead of the 30- page forms states have typically required of Medicaid applicants.
SPOKESPERSON: If you fax those tomorrow, I would have their coverage started.
SUSAN DENTZER: More than 500 Hoosier Healthwise enrollment centers were also set up at schools, Head Start programs, and other sites across Indiana. Although the state originally expected just 91,000 children to enroll in the first phase of the program, eventually more than 115,000 signed up. Another 40,000 children are expected to enroll in the second phase this year. Surprisingly, many of those who enrolled would have been eligible for coverage under Indiana’s old Medicaid program. But for various reasons, they had fallen through the cracks.
NANCY COBB: We know that an awful lot of those children were needing care and simply weren’t enrolled. We weren’t reaching out. We weren’t actively seeking them, and now we are.
SPOKESPERSON: Michelle? What’s that?
SUSAN DENTZER: Indianapolis pediatrician Nancy Swigonski says Hoosier Healthwise has already made a huge difference. For example, many previously uninsured children can now benefit from so-called well-child care.
DR. NANCY SWIGONSKI, Pediatrician: We know that children benefit remarkably from preventive care. We know that many things that… many of the morbidities of childhood are, in fact, preventable, and that by giving immunizations, by screening for leads, by performing some of these other things, we can insure the long-term health of children.
DR. NANCY SWIGONSKI: (talking to patient) I want to see your ear. Where’s you ear?
SUSAN DENTZER: It’s long been known that children without health insurance are far more likely to show up in a hospital emergency room instead of a doctor’s office for treatment of common childhood conditions like ear infections. They’re also more likely to be hospitalized for conditions, like pneumonia, that could have been successfully treated at an earlier stage. But now, with Hoosier Healthwise, Swigonski says, parents are more likely to bring children to the doctor sooner when they’re sick. These benefits, of course, have come at a price.
PATRICK KIELY, Indiana Manufacturers Association: Good morning. Any messages?
SUSAN DENTZER: Patrick Kiely is president of the Indiana Manufacturers Association, a business group that has backed Hoosier Healthwise. Even so, as a former state senator, he worries.
PATRICK KIELY: We do worry about, you know, can you bankrupt state government? Our Medicaid budget has risen by more than a billion dollars in the last four years. The majority of that is federal reimbursement, but what happens if we ever have a significant downturn in this economy again and a lot of people come back to Medicaid?
SUSAN DENTZER: But so far, Republican State Senator Steven Johnson says with state coffers relatively flush, bipartisan support for Hoosier Healthwise has remained strong.
STEVEN JOHNSON, (R) State Senator: I have not seen an erosion at all in the bipartisan support for the CHIP program, none whatsoever. The CHIP program, if designed appropriately, takes a whole generation of individuals when they are very young, and helps them understand how they are participants in their own health care.
SUSAN DENTZER: State officials have now set up a commission to determine whether CHIP should be expanded further, at least to cover the parents of children who are enrolled in the program. O’Bannon admits it could be expensive, but still thinks it’s necessary.
GOV. FRANK O’BANNON, (D) Indiana: Well, I think… I think we’ve got to continue to push forward to cover more people who are uninsured, and hopefully, at some point, make sure no one’s uninsured as far as health care.
LISA SALARY: There are 8,000 children in Lake County who need health insurance. And I’m out to find those 8,000 children, and I can’t do it alone. So if I could get your help, it would be wonderful.
SUSAN DENTZER: To many health policy experts, the state’s success with Hoosier Healthwise suggests a powerful lesson: Where there is a will to cover the uninsured, there clearly is a way.
GWEN IFILL: Information on programs for uninsured children in other states is available at our online NewsHour Web site at pbs.org. The results of a Kaiser Foundation NewsHour poll on the uninsured are also there.