Odyssey

Performances at the theater building to get information is at 7 7 3 3 2 7 52 52. I'm Dick Buckley reminding you of the time changes of my weekend programs Saturday nights 9:00 to midnight with. The great mainstream jazz artist and a sprinkling of the best of the new live Sundays 11:00 a.m. to 2:00 p.m. with a traditional good old good one from. The trend in Washington is to shift important policy choices to the states. I'm Gretchen helper today on Odyssey Dr. Quentin Young joins me and we'll talk with health policy experts about how the states including our own are using their discretion with federal funds for children's

health care. States have a lot of choices in this area and we'll compare different solutions to the problem of providing for children with no other sources of care. That's today on Odyssey next. After the news from NPR here on WBEZ Chicago. From National Public Radio News in Washington one corps of a Coleman about 500 residents of California's San Joaquin Valley hope to go home today. People from the town of early March were forced out because of a flash flood. High water has also closed one of California's major north south highway. Steve Krueger of member station reports a quarter mile section of the White River broke through its banks after heavy El Nino driven rain soaked the Sierra Nevada foothills east

of early March. Floodwaters as much as four feet deep now cover the town. Most residents left voluntarily before the flood hit after police and fire crews sounded the alarm just before midnight today. The flood is also closed U.S. ninety nine a busy main highway that connects northern California to Los Angeles. The highway isn't expected to reopen until the weekend. There is a little good news ahead for the evacuees. The weather forecast calls for sunshine and no rain for at least five days. But residents are worried that a deep mountainous snow pack could cause more flooding when it melts later this spring. For NPR News I'm Steve Krueger. Early March California President Clinton is surveying tornado damage in Florida at this hour the central part of the state was ravaged by a series of tornadoes earlier this week that killed at least 39 people. The death toll is higher than the one recorded during Hurricane Andrew. Three people are still missing and hundreds of buildings were damaged. South Korea's former leading dissident is now its

president. Kim Jong toal took office during a ceremony that included a 21 gun salute and the release of fifteen hundred doves of peace. NPR's Julie McCarthy reports. The band played Bridge Over Troubled Water has came to Joan completed a personal odyssey that has taken him from political prisoner to the highest office in his land among the thousands who gathered under cobalt blue skies former presidents who want to notate to the two ex-generals orchestrated a political crackdown 18 years ago that left hundreds dead and condemned to death. But there were no words of recrimination. The 74 year old dissident turned commander in chief called for reconciliation and economic revival. He thanked the United States and the IMF for its economic assistance. The crowd cheered when Kim proposed peacemaking with North Korea and yelled even louder when their new president plunged into a sea of well-wishers. For the first time in their history citizens were able to approach the inaugural podium unfettered by police. This is Julie McCarthy NPR

News Tokyo. New York Representative Bill Paxon is leaving Congress. He sent a letter to his Republican colleagues saying it's the toughest decision he's made the decision comes seven months after he was forced out of House GOP leadership aide helped lead a failed coup against House Speaker Newt Gingrich. Paxton's retirement ends a possible raise for another House leadership position that could have revealed a schism within Republican lawmakers on Wall Street the Dow Jones Industrials are up 72 points at 84 42. This is NPR. In NPR's business update the stock market is rebounding from yesterday's drop in record levels. Bloomberg Krisna reports the advance has been helped in part by the stability of Treasury bonds which are steady after Fed Chairman Greenspan implied that interest rate policy is on hold until the impact of the Asian financial crisis becomes more clear. The market is also being supported by overnight gains in the major equity markets in Europe and Asia. Drug stocks are higher after Pfizer was

reinstated by ABN Amro diversified health care issues are up after American Home Products was added to the priority list of Goldman Sachs and airline shares are advancing after Japan Airlines and American announced a marketing partnership. I'm dog prisoner. The Supreme Court has narrowly ruled in favor of banks in their closely watched fight with credit unions over new members. The justices ruled 5 to 4 The government has wrongly allowed credit unions to enroll new clients who should not have qualified for membership. It overturns a 15 year old government policy that allowed credit unions to accept millions of new members from outside traditional membership pools. However a new federal law is being introduced retroactively allowing this practice credit unions offer many of the same services that banks do but the credit unions can make better deals on loans and savings because they don't pay federal taxes. California farmers have been badly affected by El Nino storms. The farm industry estimates at least one quarter of the current asparagus crop could be lost to disease because of the

excess rain and artichoke industry official predicts his crop will also likely be hurt this season. I'm CORBA Coleman National Public Radio news from Washington. Support for NPR comes from Borders Books and Music in more than 200 neighborhoods across the United States where browsing is a fine art. 800 6 4 4 7 7 3 3. Good morning and welcome to odyssey on WBEZ Chicago I'm Gretchen health French joining me today is Dr. Quinn young he's back and he's healthy. We're glad to have him back in morning. And we're going to talk a little health policy today. Last year's Balanced Budget Act provided federal funds for health care for children but left a lot of implementation questions up to the states. We're going to see how the states including our own are using this money and joining us to do that

are Gerri STURMER president of voices for Illinois children. Dr. Arthur Corman associate chairman of Child Advocacy at Children's Memorial Hospital and a professor of pediatrics at Northwestern. And joining us from NPR in Washington is Joan Henneberry a health care policy specialist with the National Governors Association Joan can you hear us OK. Yes I can OK. Thanks very much for joining us this morning. Quentin let me turn to you to sort of set the stage for us give us a little background on what this legislation is and what this money is to be used for. Well you have to back up to the whole issue of national health insurance which of course we don't have. And the word that describes what happens here is incrementalism Medicare itself is incrementalism. That is a big increment it was all people over 65 and subsequently all disabled folks who qualified. And then as the twin of Medicaid which was aimed at the same 1965 legislative moment to serve the poor. And that's 965 Thessa jump forward to

the failed effort to get national health insurance and 93 and subsequent attempts to meet needs of special groups and this is perhaps an outstanding example. We shan't be able I don't think to examine a detail the wisdom or lack of it of going at it this way just for the record I think it's a madness. But it's the reality and we have people here are going tell us about this new reality because it was aimed at the children. The fact that we have many millions just how many will learn in a minute of children this country who don't enjoy health insurance protection is something that grab the hearts of both Republicans and Democrats. However we're going to examine whether health insurance is the issue for children. Either other other. Health needs to be met in a different mode. We have just the right people to do so and also we have a it's and the other important thing to say before we turn to our guest is that this is a state program. It's part of the the present mode of

shifting things back to the states which means 50 different voices. Well learn what the voice in Illinois is as good as it had. How does that rate rate with the other states. And at that point we need to mention that the voice of the state was invited to participate today but they were unable to furnish it to submit for a disc they would have liked to have been here. OK. So that you will not hear from them today we want to make that clear. Jerry STURMER let me turn to you at this point can you give us a picture of well the scope of the problem in Illinois how many children are not getting adequate health care and how many are uninsured whether that's the same group of people. And then you know what this new program is. Well I think that the question that you raise is is a really good one are we talking about adequate health care or who has insurance. I'd like to give you the numbers of children who don't have insurance. By the analysis that we did at voices for Illinois children with some other groups three hundred ten thousand Illinois children don't have insurance

now as it turns out about 100000 of them are currently eligible for Medicaid that is their parents are that poor that were they to enroll. They would have eligibility for the Medicaid program that leaves out. Go ahead. I just wanted just to clarify the number you gave three hundred ten thousand does that not include children who are already enrolled in Medicaid. That's correct Pam I wasn't counting about 700 plus thousand children are already in the Medicaid program they're that poor that that they they're eligible their parents have signed them up and they're in the program of the three hundred ten thousand uninsured children. The best we can figure out virtually all of them live in families where parents are working but not so fortunate as to have employer provided full coverage for dependents. So part of the question that's been raised in this dialogue that has occurred in Illinois since the

Congress passed this bill is are there some uninsured children whose employers provide part of the coverage. You know a portion look at will will enroll you when our plan if you the parents pay. 30 percent 50 percent 80 percent or 100 percent. And what does that population look like is a question that's on the table in Illinois and I think an important question. But you also have clearly a group of children who need to get enrolled and to have access to at least the basics of preventive care. I think the public policy goal and the right one is that children who are uninsured should at least have the benefits that everybody else does. One quick question about that. Hundred thousand probably eligible for Medicaid. OK. This this bill the money and the federal legislation contemplated rooting those people out.

Doesn't that have some money in it to find those people rooting them out from the highways and the highways I assume they're me already finding them and the lawmakers have come up with a great word out reach We're going to reach out to these families and say guess what you could enroll in Medicaid and I think it's an important part of the concept that Congress is put on the table and we in Illinois would like to get on with that I think the money's there is what I'm saying there is money available to do outreach. John Hannah Berry if I could turn to you at this point we've just gotten a brief depiction of what the problem is like in Illinois how does that compare with the problem in other states how similar or different are the problems in the different states. Illinois actually has a lot in common with the other states. Everybody is faced with the challenge of finding new and innovative ways to enroll the children that are already eligible for Medicaid. But for many many reasons I don't understand that they're eligible or don't access those services.

And the governors have a very strong policy statement that reiterates that children who are entitled to Medicaid should receive those benefits so it is a real challenge to all of the states there are about three million children in this country we believe who are currently eligible and not enrolled in the administration has made a strong commitment to coordinating efforts between federal agencies working with the states and local communities. They're proposing a national 800 number that would tie into existing state 800 numbers there. The president has proposed in his f 999 budget additional funding for outreach and some flexibility for the states as to who they can work with in communities to outstation eligibility workers. Most of the states are currently and under their new money proposing to really streamline some of the paperwork and administrative barriers that historically have gotten in the way of families accessing Medicaid Services. I have to

say to one of the real challenges with this new money because it allows states to take their eligibility for whether they go the Medicaid route or they design a new program up to 200 percent of poverty. And as Mr. STURMER said many of these kids most of these kids are living in families where somebody works. This is a whole different population that we have to reach out to and we even need to use different language. These are working people they work hard they have a lot of pride. They don't associate themselves necessarily with being low income or being at a poverty level we can't even use that language with them we have to talk about what their income is that this is a new program for working families to make sure that their children have access to health insurance. And one of the beauties of having a flexible block grant to the states. Is that if the children do have access to employer sponsored insurance but those employers do not subsidize the premiums this money could be

used to help families buy into the existing health insurance that the parent or both parents already have access to. So you can keep kids in the same system that their parents are in if that's an option that the state wants to choose. Let's open a can of worms here if I may and let's talk about the idea that seems to be underneath this all that somehow providing health insurance is the same as providing health. How far does health insurance go and I address this to all of you and I know DR CARMEN that you have things to say on this topic but how good of a match is it between providing health insurance health care and addressing the overall issue of children's health. Well there's a whole set of assumptions on anythings program that need to be examined. And while I certainly agree with Gerry STURMER and others that we ought to bring health insurance to as many people as we can there are some very troublesome issues here. One of the first question is does enroll meant in health insurance programs guarantee that you're going to get

health care. We know that for instance access to health care for even many of our Medicaid enrollees in the state of Illinois is difficult impossible to find in many circumstances. The availability of providers who are willing to take Medicaid patients has not been uniform and there are large areas for instance in southern Illinois where there are people who are medicaid eligible and Medicaid enroll for whom there are simply no providers available to provide basic preventive and pediatric health care services. And the reason that the money the reason or the reason is first of all there why these spread to disperse geographically and second of all doctors may choose the few specialists or. And this is particularly true for obstetrics services may choose not to take Medicaid patients for the money or for the money and probably a more complicated issue in terms of the social issues that I think Joan just mentioned the stigma of taking care of having a quote welfare practice.

In a can in a middle class community it's also a detriment to people taking on patients but for a lot of social and economic reasons I'm not denying the financial issues but for social economic reasons even people who are eligible for Medicaid don't always get health care. Carry on. The second point that I want to make is before we get into the question you asked the question is why are the people who are not in rolled not enroll. The assumption is that they're not enrolled because we haven't gotten them because they don't understand they have routed them out haven't written on how to use the conventional language now and I think we need to ask some really important questions of why people who aren't enrolled are those assumptions are not necessarily true. I think it is true that many don't want to be involved with a with a with a program the seen as a quote welfare unquote program. But I think there are many other reasons that have to do with. People are rolling the dice and making the choice that given the fact that most kids are well most of the time they're not going to spend their

resources or time on their children's health insurance. For instance while there is a I think a national scandal about the hollowness of our full employment figures because it covers up the fact that there are that full employment is made up of a large degree of people who don't have health benefits which is a big historical shift in this country. I think there's also a significant number who have cafeteria what are called cafeteria plans or they can choose the benefits and do not choose to have their children insured because they feel that the risk of their having a need for those funds are small. They're taking their own can a MSA medical savings account the exact gettin in their paycheck and hope their kid doesn't get it and the process of just outreach is not going to bring those people into the program. I would agree I think this is a real complicated challenge for people and outreach is multi-tiered. It's a national and local approach it means kind of changing people's mindset about the value

of having insurance that in turn allows you to access primary and preventive services. It means educating people about what what's available to them where to get it how to get it reducing all of the administrative barriers. We do know there are a lot of work has been done in the southern states to try and figure out why people don't take advantage of what's available to them and one of the things we know from those states and from some of the western states is that many of these children are American born children of immigrant parents. They don't think they're eligible or they are afraid the parents are actually afraid to access a variety of different government institutions. We also know that families who are. Going off of welfare right now and are going back to work. I don't understand that they are probably still eligible for Medicaid and that Medicaid does not apply to their welfare time limits. That's there's a big misunderstanding

among many families about that. We know that we again we have to change our messages particularly for this higher income population and separate the Welfare Reform Bill separated and linked eligibility from welfare and Medicaid and now we have to do a really good and thorough job to educate families about health insurance for their kids and why it's there and how it's useful to them. Go ahead. Well in Illinois this is a fascinating discussion that is now in the hands of the General Assembly and the governor. As well as a number of other people like our group Voices for Illinois children we were appointed to a task force that the governor assembled to try to sort through some of these questions and I need to report that we have had some very very serious and thoughtful discussions. One of the assertions put on the table recently was we need to

understand far more intelligently these questions and a an analysis is is being called for a study that will include I hope focus group discussions surveys and and some very careful looking at how people do access health insurance what is their relationship with their employer and their employer's plan. How does that all work. How do they feel about it. As we came to the table early this year appointed by the governor these questions began to be raised we asked employer groups to come in and tell us their for their read on it. We asked a variety of other groups to come in and it was clear that we need to do a lot more work so one of the next steps while what we've advocated for is let's ensure some people right now and let's keep studying this but. But I think we have a lot to learn. I want to we're having two conversations here and it's appropriate there's no

way that ultimately D-Link them. One is the bill. More people getting insurance that tired to fall for that but we heard a sort of undercurrent mostly from art and I'd like us all to revisit the determinants of health after the end of the day we're talking about giving health or maintaining healthy at least minimizing damage to kids. What role. But part of that is addressed with health insurance even though everyone has said I want to join the chorus. I'd like every kid to have health. Well I think it's important to recognize that when Congress passed the bill they said we're not happy if a state only decides to insure children for a serious illness for hospitalization. If you're going to use this money you States you must provide a comprehensive plan that is preventive as well as responsive to illness. And so I think the question that you raised if we

think our images go to immunizations well-child checkups access to a medical home are important concepts that that are contained in in the available time we have our Garman here just as just scratching the surface. Those are not you know I guess I guess since I bear the title of a physician I can ask this question. More boldly than others is having a medical home for all those virtues that you describe none of which I deny are important. Going to generally increase the health of children in our country. The major causes of morbidity and mortality of death and illness in this country are no overall good for kids who are no longer the preventable diseases. And I don't mean to sound like I'm against immunizations Obviously I'm for them but the major causes of morbidity are our children our society or now the consequences of the changes in our society like like violence like homicide like suicide like the consequences of the drug culture and

the ultimate consequences of putting huge numbers of our children and young adults into the criminal justice system. Are you saying that since the other no I'm not saying it's insoluble but I'm saying that I'm not sure that looking at medical solutions for this is is not avoiding the issues that we most have to deal with. I mean the major cause of death and with it of course those who don't die but are but are seriously injured or permanently disabled. In our society now are various kinds of violence whether accidental or intentional injury or suicide. And the best insurance can only treat after the vote. Yeah and the best we can do is provide good medical care it's like going behind the parade with a shovel. We're for that but for the good Benteke OK. Oh yeah but well but you're leading me. Yeah well I want you all to address the profound question I don't think will solve the here and now. A lot of people think about a lot of time but I think it's useful to get balance in this issue when we're talking about our children. What is voice.

Well I think up to the question of balance is very important. If a child whose whose parents earn forty thousand dollars a year and has a medical home and has an ear infection and can talk to somebody and get that in mind are rated and taken care of. Needs to be the other child who whose parents earn eighteen thousand dollars a year and has no health insurance ends up in the emergency room we all pay a much higher price because after all somebody is going to pick up the cost of the emergency room. This is it seems to me an important question it is not the violence question it's not the way the contemporary struggles that we have question but it's a balance question let's have an equal playing field when all children come to school and sit together. I hope that they all do have a medical home and I think I agree with your opening statement that we are talking incremental ism and we are trying to pick up one

group after the other after the other. And Medicaid has a serious access problem in Illinois and we may not. Make the wisest choice by enrolling all children in Medicaid but I think covering children with health insurance is an important step on the ladder and I wasn't disagreeing with that I'm just saying if the purpose of this legislation was to improve the health of children. Where do the where does the health of children find its greatest threats in our society. The example of the emergency room I agree completely that this is not the right place to practice medicine but that's fundamentally an economic issue at this point because the emergency rooms do take care of the kids and by and large they get adequate medical care. We have a much more serious problem in Chicago in terms of obstetrics. I don't know how this program is going to address this. Ninety nine point five or six percent of all children in Chicago are delivered in hospital.

We haven't we don't have any barriers to those who care to that care. Yet we have one of the highest infant mortality rates in the United States because so many of these children are born of high risk mothers who have not had a good prenatal care at a preventive services. If we're dealing with issues of infant mortality we've arrived at kind of the boundary of what we can do in terms of technology and hospitals and services. The question is if if we really want if we see infant mortality as an aspect of improving the health of children we're going to have to go somewhere else to deal with those issues of the high risk mothers. I don't see that this program except for the fact that I have to commend the state they have automatically raised the threshold for eligibility to 200 percent of the poverty level and that was the initial act. But I don't see that the program in its conception is addressing those issues because the issues of why high risk women show up at the hospital emergency rooms with no prenatal care is a much more complex social and economic and cultural issue than is simply going to be solved by health

insurance. That's the voice of Dr. Professor Arthur core of it who is now director of advocacy at the Children's Memorial Hospital with us also Terry STURMER who's president of. Voices of Illinois children on the line in Washington as John Hannah Berry who is a policy analyst expert with the National Governors Association and maybe Joan you can pitch in on the last round of thoughts of the Governor's Association address these additional questions. Well one of the things I've been impressed with in reading the plans that are coming in for the expansion of children's health insurance is you're right. This bill was not designed to address all of the complicated needs of children and families. However the states whose plans I have read and there are 18 now that have been submitted are working very hard to look at how this money and this program of providing health insurance can.

Together a sustainable system of health care for kids that doesn't include the public health services the behavioral health the preventive services education all the things that we've been talking about around nutrition and Violence Prevention and the things that do affect kids lives. So there is an awareness of the way that this is part of a larger web of issues that they absolutely should be addressed. It's very encouraging I'm glad to hear that is good to say a word if you can a team so far that all the states coming on board are there some naysayers. There are no naysayers so far. There are some states that are in the throes of serious negotiations as we speak with their state legislatures to try and come up with a match that's required. But so far all the states are

either working. They've got their plans in or they're about to submit their plans they're just waiting for some legislative approval or again for the appropriation of the match. But no state to date has said they're not going to play. John you're just the right person to ask this question I think the wisdom or let's put it a little different. The presumption of the federal shift of the state was you would illicit allowed to emerge all kinds of innovative fresh ideas that you just can't get at the top with the federal bureaucracy in Washington inside the Beltway. Is that happening as you look at those 18 plans are you interested excited thrilled discouraged I am excited half of those states are choosing to build upon their Medicaid programs and for them it makes a lot of sense. There are a number of states who have been operating their Medicaid programs under waivers and already doing quite a variety of creative and innovative approaches both to service delivery and to eligibility. So it made a lot of sense for them to choose Medicaid as the

vehicle and to build on what they've already done and they like the benefits package and they've built networks of providers so of those 18 states whose plans are in half at least. Early on are using Medicaid there. Most of them are also talking about how to go even further down the road and what that might look like. The other states are either building upon existing state designed children's health insurance programs. They're looking at employer buy ins for all the families who have access to employer sponsored insurance but can't afford the dependent premiums. There are a couple states who are playing around with the idea of MSA is for kids and tax credits but most of them are really looking at not just how to provide health insurance for kids but how does this translate into increased access to services for kids how to get. We all know that you could hand everybody a card right now and you would still have some of the same problems in terms of people utilizing the services that we all think are important. So states are addressing

that as well how to do a better job of educating people about the value of behavior how service is primary and preventive care. At this point we need to take a quick break. Let me remind listeners that this is odyssey on WBEZ Chicago we're talking today with John Hannah Berry a health care policy specialist at the National Governors Association. Dr. Arthur Corman associate chairman of Child Advocacy at Children's Memorial here in Chicago and professor of pediatrics at Northwestern and Jerry Starmer president of voices for Illinois children. We're talking about federal funds for children's health care and how they're being spent across the country. And of course we are joined also by Dr. Quentin Young. When we come back we'll open the phone lines if you'd like to ask a question or join the conversation please feel free to do so. Our phone number. Our phone number here is 3 1 2 8 3 2 3 1 2 4 3 1 2 8 3 2 3 1 2 4 this is WBEZ Chicago. WBEZ is funded in part by the John D and Catherine T MacArthur Foundation

recognizing the Logan Square neighborhood association working with local schools churches businesses and residents to build a stronger community. Further information at 7 7 3 3 8 4 43 70. Support for programming on WBEZ is provided by Steppenwolf Theater Company presenting the memory of water by Sheila Stephenson and directed by Les waters the Chicago Tribune calls the memory of water a bittersweet raucously funny tale of three sisters Steppenwolf ensemble members Martha Lavey Amy Morton and Rick Snyder are featured in the production which the Sun-Times calls fresh and surprising to get information is available through Steppenwolf 3 1 2 3 3 5 16 50. This is WBEZ Chicago ninety one point five F and you're listening to Odyssey. I'm Gretchen how French were joined today by Dr. Quentin Young along with Jerry STURMER of voices for Illinois children Dr. Arthur Arthur Corman associate chairman of Child Advocacy a Children's Memorial and in Washington Joan Hannah Berry who does health care policy with the National

Governors Association. And we're talking about federal funds for children's health care. Jerry Starmer let me turn the conversation back to you for a moment. John was talking about states individual plans for going beyond just building or expanding their Medicaid coverage can you give us some more details about what's going on in Illinois in that vein. Well in Illinois we're we're engaged in a sort of a three step process. In December governor Edgar announced a inclusion of about 40000 children into the Medicaid program as step one. And happily he also included a pregnant mothers up to 200 percent of poverty which is you know what a good reach. And that's paid for by state funds because the federal program is only about children so we have prenatal care thrown in by the governor a very important step. Phase two which hopefully we're going to begin sometime this summer will take the eligibility of what sort of a technical term here Medicaid look alike the same

services as Medicaid but we won't call a Medicaid because in title Mind is not guaranteed. That will go to one hundred eighty five percent of poverty sometime this summer. And there's two parts to that that are somewhat unique that I like a lot. One is that you don't have to enroll just in the Medicaid lookalike. You can let a latch on to an employer sponsored plan at the option of the parent. And the second part that I like a lot is we're trying to figure out how to also enroll the whole family. So if it wasn't just if it was a spouse who doesn't have coverage along with your children. Illinois is saying. Despite the limitations of the federal plan we think family coverage is important. Thirdly as we see the results of the study that I think I mentioned a few minutes ago of its being commission to look at this more closely we hope and the governor hopes to take the program to 100

to 200 percent of poverty double the poverty level by let's say this time next year. So I think we have a thoughtful process there's a lot of questions that still have to be worked out. Outreach is really important how do we market this. How do we make sure that people don't have to take off a day of work and go and sit in the plastic chairs at the welfare office just sign up we don't want that. We want people to babydoll enroll at a daycare center or community center or a community clinic. There's a lot of details still to be worked out but I think we have a thoughtful process and one that has. Enabled members of the General Assembly to be at the table as well. I want to go to the phones in a moment but can I ask you to give us an idea about how much money we're talking about in Illinois. Actually a lot of money the federal government will send us up to one hundred twenty two and a half million dollars annually. We won't get there in this first year. We have to put up state taxes 65 million

dollars. So that's a lot of money. There is a whole complex discussion about copays cost sharing what do the families pay. And depending on the level that we agree on hopefully a lower level and we could talk about that. We'll have even more money so it's upwards of 200 billion dollars. Can you tell us what poverty level is these days about. We're looking at about 13000 for a family of three. So this program would enable families of three of about $26000. OK let's turn to the phones Our number here is 3 1 2 8 3 2 3 1 2 4 8 3 2 3 1 2 4. Let's talk to Maria. Good morning Maria. Good morning. I'm an independent health policy and analyst and what I've heard here this morning leads me to believe that you folks have not been paying attention to the research we do in fact know why people who are constitute the working poor and don't have health insurance even though they are offered it don't buy it. We do know what will work. There are

examples of what will work and I'd like to explain. First of all there was even recently an article in Health Affairs in the November December issue done by a couple of economists at the Agency for Health Care Policy and Research the federal agency and they confirm results that the Employee Benefits Research Institute and the Robert Wood Johnson Foundation of had in the past. And what they have found is that first of all the working poor and low paying jobs are least likely to be offered employer sponsored insurance when they are they have a lot of cost sharing which is to say cost shifting they have to bear the burden of the cost themselves. And third they can't afford the premiums. And this is really a problem when they are offered and can manage to squeak out a premium. They tend to insure the employed person so that the employed person stays healthy and can keep on working otherwise the entire family suffers. And this is a trend like I say that has been confirmed by the Employee Benefit Research Institute. As far as trying to have programs by and programs for the working poor up to 200 percent of poverty level that work. There is only

one successful program ever in the United States and it still exists. It's called the Washington basic health plan it exists in the state of Washington. It is not a Medicaid buy and it is a separate program. It guarantees that there will be in fact providers that will provide care to the eligible group because it signed up only HMO PPO which is not a big scandal in Washington they actually know how they work there and are not hostile to them and it happens to work with a subsidy on the premium. The problem is is that the cutoff point is at 200 percent of poverty level and it's a sliding scale. Support for premium support and as you approach 200 percent of poverty the previous are still too expensive to get everybody in there. A Washington basic health plan is limited by what the Washington state legislature is able to provide to support those premiums. So unless you can get up to about 300 percent of poverty level and devote more taxpayer money to this which by the way was really the one issue in national

health reform you know it was. Once people figured out what this possibly could cause it was I've got mine screw you so. You still end up with a dilemma. But in fact we know what works. We know how to do it. The question is do we have the political will to raise the money to do it this way. Dr. Carmon you want to respond. Well thank you for your call Maria. Thank you do you put some definitive dimensions on one of the things that I was talking about which is the fact is that when people have choices to insure it's not children they insure for a lot of reasons. And I am aware of the studies of with it which you mention which is why I brought up the question initially about whether or not these plans would in fact do what they were intended to do. The question of buy in is a terribly important one. In fact there is there's been some discussion in Illinois about allowing the private sector to put together an enlargement of what's called the CHIPs program the Child Health Insurance Program which was put together to try and help people who had children with chronic illnesses to get

affordable insurance. That program has been a modest failure simply for the same reason that you mention just making insurance available doesn't mean that it's affordable. And I think it's a principle that I'm glad you bring up that we have to look at whenever we talk about buy in programs. Any other comments. Well I just don't I don't this is allowable under the bill as I mentioned earlier that states could indeed use their money and there is a kit. There's also a cap in the bill that families are not supposed to spend more than 5 percent of their gross income annually on co-pays and premiums so I think if a state the states that are looking at this as an option to help purchase insurance through employers there are some rules and restrictions that they must follow. I also want to say there are several other states besides Illinois that are looking at family coverage and states would need a waiver from the Health Care Financing Administration

to do that because the money was intended for kids. But if you can demonstrate that it's cost effective to go ahead and purchase insurance for more family members and not just kids that is allowable under a waiver. Yeah but you gotta remember that 5 percent of $26000 is still a pretty good sized chunk of a family's budget particularly when they're at that level. Well we have an interesting analysis by a Washington based group the Urban Institute that looked at premiums premiums are different than that and co-pays of course but when premiums were set at 5 percent of family income only 18 percent participated in the program. Thank you. Sign their children up when premiums were set then at 3 percent of family income the participation went up to 35 percent. When premiums or at one percent of family income 57 percent participated. Still not enough in my estimation if if our goal here is to let you have

children have a medical home immunizations Well child care etc.. We got to figure out a formula that enables virtually everybody to participate. Thanks very much for that. Seems to me that all of the data in this is been collected for 30 years. The whole issue of co-pay barriers to utilisation the marketeers are telling us that once you have these barriers people run amok keep getting free care as much as they can. Where in the alley what it does is act as a barrier based on your income. I think that another barrier in the face of plenty of existing barriers were exactly but it only does that it's a remarkably effective tool to do the opposite of what you want to have happen. Well our number here is 3 1 2 8 3 2 3 1 2 4 3 1 2 8 3 2 3 1 2 4 and we're talking about children's health care into Illinois in Illinois and around the country. And let's talk with Laura Good morning Laura. I am tired. My name is going to go blind and I'm the policy director at the

ANA caucus for adolescent house. I just wanted to add into the conversation adolescent what I've taken to call the program the Children and Youth Health Insurance Program. Because when we talk about children this program does go up to the age of 18 and many times we forget about the issues of adolescent that are that could be addressed by this program. Adolescents often have a low with health insurance coverage is in families and their access to care and they're usually utilization of care is often low. And while I think all of the issues the barriers that you're bringing up in this conversation are extremely relevant and important. I guess I'm still hopeful that this program if used in a really positive way could do a lot of prevention around adolescent house. And we know that many long term chronic health problems start in adolescence whether it's smoking or drug use or. Or whatever. And that adolescent health problem of teenage pregnancy and at the rate can well birth weight and all variety of issues but eventually could be addressed if we do

really good outreach and not only bring in adolescent to health care but also expand the network of providers that are adolescent trained and actually been doing work with adolescents. So I just wondered if the group could offer comment on that. I'm delighted to endorse everything you said I think it's important to remember though in another in another way and you touched on this that of all groups of people in my experience who it's hardest to figure out why they don't access services that are available it's adolescence. This is got to be one of the most complex problems and outreach to this group is a very complicated issue as I'm sure you would agree. There's a whole variety of social cultural and group relationships that have to do with what you do and what you don't seek healthcare for and how you do it in that group. This is where the research is needed as much as in any group that I know of. The second point is to support you in saying that it's also in adolescence that the largest toll of to is taken not on what we ordinarily call medical illnesses or the things that we talk about medical insurance

but the toll of violence and as you point out of the acquisition of life habits which are ultimately destructive or impair life or length. It is acquired. And this is where a simple medical or even complicated medical approaches are not necessarily going to reduce the toll on children self no less an age period. Laura thanks very much for your call. Numbers 3 1 2 8 3 2 3 1 2 4 8 3 2 3 1 2 4. Let's talk to Adam good morning Adam. Yes good morning Heidi. It's one of the proposals I I heard was to subsidize employers to provide group insurance to to to the families of their own workers. It strikes me as a bit unethical to subsidize employers. It seems to me that when employers are getting the full benefit and value of their employees services

and. The government should not step in and encourage employers to pay less than adequate wages to do their voice I mean to me we just seem to to to exacerbate the problem. You mean it encourages employers not to pay employees not to to continue to give their employees inadequate benefits or inadequate wages. And even though I like our guests to comment on this. It's been suggested that employers will stop giving benefits because here's this government subsidy that is inherent in the caller's question right in a very complex issue that that is being discussed at the governor's task force with a lot of vim and vigor. They've come up with a great word called crowd out. Are we going to crowd some employers out of the other set I think Adam has raised the issue exactly the way it should be raised. We should not have a government policy that encourages some employers to

do less than others. Now there is federal law that says if you provide a benefit for the CEO you must provide the exact same benefit for everybody else. I like that. So you can't suddenly say well just because this person you know has a different job I'm going to offer. The question is whether it's affordable The CEO may be able to afford to buy in. And the the the you know the person taking the tickets. Not so. Illinois is struggling with this not going to give benefits to employers but vouchers to employees to pick up the portion that they cannot afford. There will be more rules there'll be more debate. I hope you'll weigh in as this debate goes on in Illinois. Joan had a very Can we ask you to give us an idea of of how popular or unpopular this idea is around the country of using some kind of employer subsidy or

employer inducement as a mechanism for supplying health care health insurance. It's more along the lines of what Gerri is talking about it's not so much subsidizing the employer it's providing subsidies to the family or additional monies to the family so they can afford to purchase pay the premiums and to buy health insurance that they have access to but they cannot afford because of other pressing needs and priorities in their budgets. Would you say generally the idea of subsidizing the employer that that's just not that's out of favor or just not. I can't say it's out of favor I can I can tell you that I have not read in any of the plans or the proposals I've seen that's not the way states are approaching it. Many states are looking at the wisdom of helping families who have access to a group plan. Go ahead and pay those premiums but I haven't seen anybody propose what they would call an employer subsidy and the the crowd issues of great concern to Congress and to the administration this is very important and

again the governors have a policy that they definitely want to see safeguards to prevent employers from reducing or eliminating their existing coverage for kids they don't want to see that private sector coverage erode. And I wouldn't be me if it this late in the program I hadn't made the obvious observation that this Mickey Mouse of cobbling together a variety of point counterpoint solutions to a national problem would best be met by universal national health insurance. I'd be in favor of a single payer system and I would also try and avoid venture capital participation in the in the effort. But no one who's heard going on the station before fails to know that about him. Well I think though that if those of us who have watched several turns of this we need to reflect on something an assumption which I don't think is generally acknowledged in our society. The growth of labor in this society was tied intimately to the growth of health benefits and labor

unions Grable unions the labor movement succeeded during the 30s and the 40s in the 50s and into the 60s. In in actually making the the turning points of their negotiations with industry health benefits we are now living in a time where employment and health benefits are no longer coeval in which we can no longer assume that employment and health benefits occur together and this is a important serious change in our society. Weak and is and again I agree with Quinn in the sense that what we're doing is cobbling at this rather than coming to the point that sooner or later we have to face the fact. And I'm sympathetic to the employers as well. I mean one when the cost of health benefits exceeds the cost of the raw materials for the product they're making They have to as prudent managers begin to ask should we be limiting these. And I really believe the only solution is going to be to first of all acknowledge that we're way down the road in that divorce between employment and health benefits and not look at piecemeal solutions

but look at where we're going in terms of solutions for the entire society. Ok lets shoehorn one more call in before the end of the hour let's talk to Sal. Hi Sal. I work for an employer for 30 years here in Chicago so when we heard and I found it in their best interests you sleep well dressed you freeze up. They found that by going to prenatal classes they could dramatically reduce the incidence of the Syrian birth which reduced their costs. And I wondered if some of these government funds could be used as incentives. Wellness issues even within the adolescence that some of the staff maybe some of these funds could be used for education with regard to drug violence I realize that's not a medical problem. Why don't we prevent the problem rather than trying to spend money to fix it. Well your little germ or you were mentioning that prevention is definitely part of the part of the approach part of the vision of this particular round of funding but what about the second part of a point

about education and maybe drug prevention are those sorts of things makes a very good point and I think that we ought to be open to that in Illinois. Either using this pot of money or existing pots of money which we have you know pretty big budget here in the state of Illinois it probably needs to be bigger. But these kinds of strategies to accomplish the kind of goals that that our corpsman has been talking about must be on the top of our agenda we can't sit back and say well everybody got covered with health insurance and then recognize that that the fundamental education and preventive strategies aren't happening. And so a comprehensive approach is the only way we know once we put this insurance to plan together. Let's not back away from the table this is an important table Wellwood that just brings us to the end of our show we're just about out of time. But I do want to thank all of our guests for

participating today that was Jerry STURMER The president of voices for Illinois children. Dr. Arthur Corman is associate chairman of Child Advocacy at Children's Memorial Hospital and professor of pediatrics at Northwestern. And joining us from NPR in Washington Joan had a very a health care policy specialist with the National Governors Association thank you to all of you for joining us. John thank you to you there in Washington. And of course thanks to Dr. Quentin Young for coming in and staring us in the direction of these very important issues thank you Quentin. My pleasure. So we'll see you in a couple weeks probably you know probably about a month this time. And then we think we'll probably be seeing you about every two weeks I look forward to that will iron affords nightly for a fortnightly encounter. Oh that sounds very exotic. Well thank you to all of our callers today. Thanks also to Joshua Andrews for producing and directing and to Steve Warner asked us and a very Winograd for engineering. Coming up tomorrow on Odyssey we have sort of an odd program we're going to take a look at the legacy of dramatist poet song lyricist. Just about everything

Bertold Brecht 1098 is the hundred and hundred anniversary of Breck's birth and his influences continues to be felt around the world. He's had a lasting and profound impact on American theater we're going to talk about him and his legacy both here and in his home country of Germany tomorrow so I hope that you'll tune in for that coming up next world view with Jerome McDonnell. Stay tuned. This is Odyssey I'm Gretchen Healthwatch And you're listening to WBEZ Chicago. Today's program is in honor of our granddaughter.