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Safety net should catch poorest kids

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Our view: Every child in California should be covered by health insurance. Bureaucratic barriers that keep poor families from getting or hanging onto coverage should come down.

On principle, these truths seem self-evident, easy for all but the most mean-spirited to agree upon. So why hasn't Gov. Arnold Schwarzenegger yet signed a Legislature-approved bill sitting on his desk that would accomplish both of these worthy goals? As usual, it all comes down to who picks up the tab.

An admirable coalition of faith-based groups, children's advocates and health care organizations are backing what they call the California Healthy Kids Initiative. They want Schwarzenegger to sign legislation that would increase access to affordable health insurance for every uninsured child in the state; make enrolling in and retaining coverage easier for poor Californians; set up a state panel of experts to guide the policies; and send Sacramento lawmakers the bill —— it could top $1billion —— for this significant expansion of the social safety net.

This last element is the most problematic, for the governor and for us. Advocates proposing a big spending bill should at least have some idea where the money will come from. Healthy Kids proponents suggested private donations could pick up much of the slack. It's wishful thinking, and they know it. We'd be willing to consider a tax increase to cover the state's poorest kids; so should they. That may make the political hill that much harder to climb, but at least the effort would be honest.

Aside from the mystery funds, the Healthy Kids bill faces a likely veto because it pulls precisely when Schwarzenegger and the nation's other governors have been straining to push state-funded health care in the opposite direction. Despite a 2003 campaign pledge to insure all of California's kids, the governor lately has been working to shrink the Medi-Cal rolls and cut red ink at the state's health insurance program for the poor.

Driven by soaring prescription drug prices and higher enrollment, Medi-Cal spending has almost doubled in the past seven years. The $33 billion annual program funded by the state and federal governments now covers one of every six Californians. So the governor has pushed for changes that would require more recipients to pay for parts of their health care coverage and would kick more people above the federal income thresholds off the program.

Both ideas have merit. If protecting the poorest is the program's goals and the state's $7.4 billion deficit requires thrift, then the state is obliged to narrow Medi-Cal's scope.

At the same time, society has an abiding interest in keeping its children healthy. Serious health problems can be identified early and managed effectively. Educational outcomes improve when chronic illness is treated. More important, taking care of our children is just the right thing to do.

Whether he vetoes the bill or not, Schwarzenegger would be wise to embrace many of its proposals.

Most promising are a series of administrative changes that would streamline the application process for getting children enrolled in health care coverage. One, for instance, would stop making applicants provide redundant evidence of incomes, as long as they qualify for other federal entitlement programs, like food stamps and the school lunch program, that have the same qualification thresholds.

As one advocate put it, how easy would middle-class folks find it if they had to stand in line to reapply for employer-sponsored health care coverage four times a year. If forced to rely on North County's insufficient public transportation, the hurdle would seem that much higher.

This kind of administrative change could make a big difference in making low-cost health care that's available also accessible to families already struggling to make ends meet. If the reform-minded governor is still interested in "blowing up the boxes" of the state's bureaucracy, he would do well to start here.

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