State health insurance for kids: There are limits

Washington lawmakers’ well-intentioned effort to extend health insurance to all children in the state has not been going smoothly.

Both this year and last, the Legislature appropriated more money for the publicly subsidized programs that pay for children’s medical care. This year’s expansion was a big one; with federal help, the state is expected to spend $45 million providing coverage to roughly 50,000 children.

That projected cost has jumped from $29 million since the Legislature adjourned, because Gov. Chris Gregoire’s administration had underestimated the number of eligible children by a whopping 10,000. It was a rude shock for legislators who thought they knew what they were voting for.

And Joe Zarelli of Ridgefield, the ranking Republican on the Senate budget committee, has been making headlines by pointing out – as he did during the session – that most of the money will be spent insuring illegal immigrants and other non-citizens. Meanwhile, the state isn’t doing the same for many poor adults who are citizens.

A good fiscal argument can be made for covering undocumented children. Legal or illegal, they still get sick. Hospitals are required to treat everyone who shows up with serious illnesses, so uninsured children of any origin typically rack up large bills that either get paid by the taxpayers or wind up indirectly shifted to people with private insurance.

Preventive care and early treatment on the front end of an illness can save a lot of money on the back end.

But the concern about poor adults is not misplaced. It seems odd that the new subsidies will be extended by 2009 to households earning as much as $62,000 – three times the poverty level for a family of four – while adult Washingtonians with much lower incomes are frozen out.

That upper range also seems questionable in light of the way it is expected to entice many families to drop private insurance for cheaper state-subsidized coverage. To the extent that good private insurance is being supplanted by public insurance, this amounts to a middle-class entitlement whose funding could have been better spent in other places.

One of those places might have been the medical and dental practices that are struggling to treat low-income patients in the face of the state’s miserly Medicaid reimbursements. This problem is serious enough that needy Washingtonians often have a hard time finding a doctor or dentist willing to treat them.

Insuring children is a worthy (and politically appealing) cause. But it shouldn’t trump everything else – including the health of the struggling adults who are often caring for those very children.