[Congressional Record Volume 143, Number 13 (Wednesday, February 5, 1997)]
[Extensions of Remarks]
[Pages E160-E161]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




        FLORIDA'S HEALTHY KIDS PROGRAM: A MODEL FOR THE NATION?

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                      Wednesday, February 5, 1997

  Mr. STARK. Mr. Speaker, it is America's shame that 10 million 
children--mostly the children of working parents--do not have health 
insurance. Health insurance equals access to health care. Lack of 
access to health care equals increased deaths and diminished lives.
  We must find a way to insure these children.
  Florida has developed a program run through the schools that provides 
a comprehensive set of benefits for children for about $50 per month. 
The Robert Wood Johnson Foundation is giving $3 million in grants to 
seven other States to see if they can replicate Florida's success.
  Following is material from the RWJ Foundation's ``Call for 
Proposals'' which describes the Florida program. I think that the 
Federal Government might look to this State example as a way it could 
quickly and efficiently reach most of the 10 million uninsured. If we 
used President Clinton's $500 tax credit idea with a program of school-
based health insurance, we could obtain low cost but comprehensive 
insurance for millions of children without new bureaucracies or 
hassles.
  I urge everyone to think how we could combine the Florida idea with 
Federal tax legislation to make new money available to end the national 
disgrace of 10 million uninsured children.


                                purpose

       Healthy Kids is a program designed to help states develop a 
     comprehensive, affordable health insurance product for 
     uninsured children. The program, initiated in 1988, provides 
     grant funds to replicate a successful model in Florida that 
     helps families that do not qualify for government aid--but 
     that cannot afford private health insurance--buy health 
     insurance for their children. Florida Healthy Kids is a 
     subsidized insurance product sold through schools. School 
     districts are used as a grouping mechanism to lower the cost 
     of insurance for children, similar to the role employers play 
     in providing group coverage to their employees.
       Up to $3 million has been made available for the Healthy 
     Kids replication program. Under this three-year competitive 
     program, approximately seven states will be awarded grants. 
     These include planning grants for states to develop their 
     programs and implementation grants for those ready to 
     proceed.


                               background

       One child out of every seven in America does not have 
     health insurance, according to a 1996 study by the Employee 
     Benefits Research Institute. The number of uninsured children 
     is increasing and current trends in private health care 
     coverage and welfare reform threaten to accelerate the rate 
     of increase.
       The majority of Americans get their health insurance 
     coverage from group insurance plans provided through their 
     employers. Historically, covering a worker generally meant 
     covering his or her children as well, but rising health care 
     costs have begun to change that. Recent years have seen a 
     drop in employer-provided dependent coverage

[[Page E161]]

     (from 61 percent of children in 1988 to 54 percent in 1993). 
     Additionally, many lower-wage workers cannot afford the 
     higher costs of family coverage.
       Expansions in state Medicaid programs were able to cover 
     many children who otherwise would have been uninsured. But 
     rising health care costs and recent changes in federal 
     welfare rules have many experts predicting that further 
     expansions will not be possible. The result of these two 
     trends is that children are 40 percent more likely to be 
     uninsured than adults. For children with medical problems, 
     lack of insurance doubles their chance of not getting 
     care.
       Very few insurance companies offer policies only for 
     children, but a model program, Florida Healthy Kids, has 
     demonstrated that a children's insurance product has a place 
     in the market. The feasibility of a children's school 
     enrollment-based health insurance program was first explored 
     in a 1988 University of Florida study and in a subsequent 
     pilot program, jointly funded by the State of Florida and The 
     Robert Wood Johnson Foundation. The program designed a 
     children's insurance product and used school districts to 
     group children into purchasing pools to make the product 
     affordable. The product was sold to families who did not 
     qualify for government aid, but could not afford private 
     health insurance for their children.
       Moving the insurance contract from the employer to the 
     school district also enhanced the portability of coverage, 
     especially for families with a child with a pre-existing 
     condition.
       A recent evaluation of the program found a 70 percent 
     decrease in emergency room visits per enrollee. In 1995, 
     enrollees had more than 110,000 primary care visits, more 
     than 9,500 children were immunized and 719 children received 
     eyeglasses. Teachers also reported improved attendance in 
     school.
       The Florida Healthy Kids model has two goals: create a 
     comprehensive insurance product for school children and 
     facilitate the provision of preventive care for children. The 
     Florida program has the following components:
       Eligibility: All children enrolled in school grades K-12 
     are eligible to participate in the program. Pre-school age 
     siblings may also join.
       Benefits: The benefits package emphasizes prevention and is 
     designed specifically for children's medical needs. It 
     features inpatient and outpatient care, including dental, 
     vision, and mental health. There are no pre-existing 
     condition limitations and no medical underwriting. Co-
     payments are required for some services, such as emergency 
     rooms, eyeglasses, office visits, and prescriptions. In each 
     school district, insurance companies bid to participate in 
     the program. To participate, companies must demonstrate that 
     they have an adequate and accessible network of providers.
       Role of the schools: Schools serve as the central 
     institution within communities, fostering relationships 
     between the local project, community leaders, and area 
     business groups. Schools also verify student enrollment, 
     distribute marketing materials and applications, provide 
     parent outreach, enhance health education opportunities, and 
     provide interpreters and translators for program activities 
     and materials.
       Financing: Premiums are covered by a combination of state 
     and local/community funds, as well as family contributions 
     based on a sliding scale. In Florida, the state contributes 
     25 percent, local/community funds comprise 40 percent, and 
     families contribute approximately 35 percent of the premium. 
     The state's initial contribution is higher, allowing 
     communities to implement the program with minimal start-up 
     contributions (approximately five percent). The state portion 
     declines over time as the local match and program enrollment 
     increases.
       Administration: In Florida, the Healthy Kids Corporation 
     facilitates the efforts of all the parties in each site. This 
     state-funded, 501(c)(3) corporate entity, manages the 
     contractual arrangements for billing and administration of 
     the product, and manages the bidding process with insurers at 
     each site. A private third party administrator (TPA) helps 
     with initial eligibility determinations, and handles the 
     enrollment functions by processing applications and 
     collecting monthly premiums paid by the families. In 
     addition, the TPA verifies continuing eligibility by checking 
     monthly to see that program participants are not receiving 
     any services through the state Medicaid program.

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