[Congressional Record Volume 143, Number 42 (Thursday, April 10, 1997)]
[Extensions of Remarks]
[Pages E635-E636]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




     REGARDING THE WESTERN PENNSYLVANIA CARING PROGRAM FOR CHILDREN

                                 ______
                                 

                         HON. WILLIAM J. COYNE

                            of pennsylvania

                    in the house of representatives

                        Thursday, April 10, 1997

  Mr. COYNE. Mr. Speaker, in 1995-96, there were 23 million American 
children who did not have health insurance for all or part of that 2 
year period. This is one out of three children. Further, recent 
research suggests that the number of children who have access to 
privately sponsored employer-provided health insurance benefits is 
declining.
  I would like to highlight an important program in my State of 
Pennsylvania that is providing a critical point of entry to the health 
care system for thousands of children. The Western Pennsylvania Caring 
Program for Children, administered by the Highmark Blue Cross Blue 
Shield Program and financed by a State tobacco tax and private 
donations, has succeeded in providing health insurance to nearly 60,000 
children in Pennsylvania. In Pennsylvania, nearly 92 percent of newly 
enrolled children in the Caring Program have parents who work full 
time--they simply cannot afford the high cost of health insurance.
  The following is an article on this highly successful program that 
appeared in the Washington Post on April 1, 1997. I commend the Caring 
Program and the Highmark Blue Cross Blue Shield Corp. for the 
determination and perseverance in helping the families of Pennsylvania 
provide their children with the opportunity to lead healthy lives. It 
is my hope that the 105th Congress can look to the example set by the 
Caring Program and the Commonwealth of Pennsylvania and pass 
legislation that will provide every child in America the same 
opportunity to receive needed health care services that Pennsylvania's 
children have.

                [From the Washington Post, Apr. 1, 1997]

                           Insuring Children

                         (By Steuart Auerback)

       Irwin, PA.--Jodie Gavin's serene middle-class lifestyle 
     ended in the wreckage of a car crash that killed her husband, 
     Larry, and his brother 3\1/2\ years ago on what she now 
     ruefully describes as a ``chance-of-a-life family vacation'' 
     to see relatives in Ireland.
       The vibrant young wife and mother of two young sons was 
     transformed into a 28-year-old widow who was forced to cope 
     without her husband's paycheck and benefits to pay for all 
     the normal trappings of life: mortgage payments on a neat 
     one-story home, health insurance, money for food, clothing 
     and recreation.
       ``We came home and the kids were crying. They asked me, 
     `Will we have to move from our house, Mom?' '' Gavin 
     recalled.
       Another big worry was health coverage. Her youngest son, 
     Philip, now 6, suffers from congenital heart disease that so 
     far has required three operations. The family had been 
     covered through the husband's job as a maintenance supervisor 
     at the University of Pittsburgh. Although Gavin could have 
     continued her husband's policy, the $650-a-month price tag 
     was beyond her income of $1,476 a month in Social Security 
     benefits.
       ``It was either food on the table or health insurance or 
     pay the mortgage or health insurance. Social Security meant I 
     was too rich for medical assistance, and I couldn't afford to 
     buy insurance myself,'' she said.
       ``Those were really hard times. I didn't know what to do. I 
     was afraid we'd all end up on the street somewhere.''
       Her most immediate health concern was Philip's heart 
     problem.
       A relative told Gavin about the Western Pennsylvania Caring 
     Program for Children, a private community initiative, 
     administered by the local Blue Cross Blue Shield 
     organizations, to provide health insurance to children of 
     parents who can't afford to buy it themselves but whose 
     income is too high to qualify for federal-state Medicaid.
       Gavin was able to enroll Philip and Larry, 9, without a 
     waiting period. Once enrolled they had their own Blue Cross 
     Blue Shield card; as far as any doctor or hospital knew, they 
     were members of the health care plan. But the cost of the 
     insurance was borne not by the Gavin family or a private 
     employer, but by the Caring Program, which is funded through 
     charitable donations and state funds.
       While the Caring Program only covers children from 1 to 19, 
     Blue Cross Blue Shield offers low cost coverage to parents of 
     children in the Caring Program for $730 a year. ``I was 
     devastated by my husband's death. But because of the Caring 
     Program, I knew that my children could stay in this house and 
     that I could clothe them, that I could feed them and that I 
     could love them,'' Gavin said.
       The Pennsylvania program is gaining attention as a national 
     model for covering the growing ranks of uninsured children, 
     estimated as totaling 10 million across the nation.


                        a full range of benefits

       The 12-year-old program, now expanded to the entire state 
     and financed largely through a two-cent-a-pack tax on 
     cigarettes, provides health insurance for 60,000 Pennsylvania 
     children 26,000 in the 29 counties of western Pennsylvania. 
     The program provides a full range of health care benefits 
     including visits to doctor's offices, immunizations, 
     diagnostic tests, emergency care, outpatient surgery, dental 
     treatments, vision and hearing care, prescription drugs (with 
     a $5 co-payment), mental health care and hospitalizations.
       While the coverage is free for eligible children, Charles 
     P. LaVallee, vice president and executive director of the 
     Caring Program, calculated the cost of the insurance at $850 
     a year for each enrolled child.
       ``Covering kids is relatively cheap. Extending coverage to 
     more children should not be a big financial burden,'' said E. 
     Richard Brown, director of the University of California at 
     Los Angeles Center for Health Policy Research, which studied 
     uninsured children in California.
       The Western Pennsylvania Caring Program has been replicated 
     in 26 states by Blue Cross Blue Shield. In some states, 
     including Massachusetts, the program is financed by increases 
     in the cigarette tax.
       Pennsylvania's children health insurance program is 
     targeted largely to middle-class

[[Page E636]]

     working families who don't get health insurance for their 
     children as part of their employee benefits and don't earn 
     enough money to buy insurance on their own. They also earn 
     too much to be eligible for Medicaid. Under the Pennsylvania 
     program, a family of four earning $28,860--185 percent above 
     the $15,600 poverty line--qualifies for free health insurance 
     for their children.
       In western Pennsylvania, 92 percent of newly enrolled 
     children have parents who work full or part time. This 
     reflects the national profile of the uninsured. A UCLA study 
     found that nine of 10 uninsured children in California come 
     from a working family and 60 percent of the uninsured 
     children come from families with at least one full-time 
     working parent. The Children's Defense Fund found similar 
     figures in a national sampling, as a growing number of 
     parents are working for employers who no longer offer health 
     insurance for children as a benefit.
       A new study released last week by Families USA Foundation, 
     based on federal census data, reported that an estimated 23 
     million American children were without health insurance 
     coverage for at least one month during a two-year period.
       ``America's uninsured children live in families where the 
     breadwinners work hard, pay taxes and play by the rules. But 
     they don't get health coverage on the job, for themselves or 
     their children. And they can't afford to pay for it out-of-
     pocket,'' said Ron Pollack, executive director of Families 
     USA.


                      avoiding trips to the doctor

       A typical situation is that of Susan Din, executive 
     director of the Ligonier Valley Chamber of Commerce.
       ``I almost called for help,'' said the mother of two 
     teenage daughters.
       ``My husband has been out of work for two years, and I was 
     taking care of a family of four on my chamber salary of about 
     $20,000 a year. We had no insurance for the kids or 
     ourselves. There was no way we could have afforded insurance. 
     It was just food on the table and mortgage payments,'' Din 
     said.
       ``I just kept saying to the kids, `Don't get sick.' ''
       Without insurance, Din also avoided going to the doctor. 
     The family was lucky. There were no injuries or major 
     illnesses. Her husband, Angie, now has a job with an axle 
     manufacturing company in Michigan, where the family will move 
     after the school year is over.
       ``I can't wait until we get insurance [from her husband's 
     new job],'' she said. ``I haven't seen a doctor in three 
     years.''
       She explained that she didn't sign her children up for the 
     Caring Program because her family was not destitute. ``We had 
     a nice house and investments we could tap into. We are not 
     like people who don't have anything. There's a lot we could 
     have gone through before we got to the place where a lot of 
     people already are,'' Din said.
       ``But I still was afraid to go to the doctor in case he 
     found something wrong. That could wipe us out.''
       That is a common fear among parents with no health 
     insurance for their children. A survey taken for the Caring 
     Program by the University of Pittsburgh health economists 
     Judith R. Lave and Edmund Ricci found that three out of four 
     parents of uninsured children postpone going to the doctor, 
     preferring to save that cost to pay for medical care for 
     their children.
       Because they can't afford it, many parents also put off 
     getting needed treatment for their children.
       As a result many of the children who come into the Caring 
     Program have unmet medical needs. The Pittsburgh study found 
     that one in four new enrollees needed to see a doctor for 
     untreated ailments such as asthma, bronchitis, bruised 
     kidneys, depression, diabetes and sprained ankles. The 
     illnesses were caught before they caused permanent damage, 
     and the researchers said treating them meant the children 
     grew up to be healthier adults.
       More than four of every 10 children enrolled in the Caring 
     Program needed dental care and almost two in 10 needed 
     glasses.
       The lack of health coverage also affected the family's 
     lifestyle. In the study, about 12 percent of the children 
     were forced to restrict activities such as bike riding and 
     ball playing because parents feared their children would get 
     hurt.
       ``They wouldn't let their children engage in a sport that 
     they feared would lead to an accident and a need for 
     emergency medical care they couldn't afford. I was surprised. 
     It had never occurred to me that lacking health insurance 
     would keep children away from playgrounds and out of 
     sports,'' Ricci said.
       But this was no surprise to social workers in the 
     community. ``I can't tell you how many parents say, `Now he 
     can play baseball again,' '' said Kimberly Rodd, an outreach 
     coordinator for St. Michael's of the Valley Episcopal Church 
     in Ligonier. The church both raises money and seeks out 
     children for the program.
       ``Schools require physicals before a child can participate 
     in organized sports. They can't afford physicals if they 
     don't have health insurance,'' added Amy Salay, a counselor 
     for the Ligonier schools who steers children into the Caring 
     Program.


                         Founded After Layoffs

       The Western Pennsylvania Caring Program was born after 
     massive layoffs hit the steel mills that had been the bedrock 
     of the region's economy. Teams of ministers asking about the 
     needs of thousands of formerly well-paid laid-off 
     steelworkers were told:
       ``Don't worry about us. Do something for our kids,'' 
     recalls LaVallee, who was studying for the ministry at the 
     time.
       The ministers settled on offering a basic package of 
     primary care health coverage for children, financed by 
     community donations matched by Blue Cross of Western 
     Pennsylvania and Pennsylvania Blue Shield, now merged into a 
     single organization, Highmark Blue Cross Blue Shield. The 
     Blue Cross Blue Shield organizations took an active interest 
     in the program, donating the administrative services that 
     keep it going.
       In the beginning, the benefits were far from 
     comprehensive--doctors' visits, immunizations, diagnostic 
     tests, emergency care and outpatient surgery--but the cost 
     was low, just $13 a month for each child, which amounts to 
     $156 a year.
       LaVallee and others raised the money from the community by 
     holding bake sales and making the rounds of Kiwanis Clubs and 
     church groups. They argued that every $156 raised from the 
     community would be matched by the Blues and thus would 
     provide health insurance for two children.
       Community fund drives remain a part of the Caring Program, 
     accounting for $500,000 to $900,000 a year. But LaVallee said 
     he quickly realized community support could go only so far. 
     The explosive growth for the program came in 1993, after 
     Democrat Harris Wofford won a U.S. Senate seat from 
     Pennsylvania on a platform favoring national health 
     insurance. He upset former governor and U.S. attorney general 
     Dick Thornburgh, and helped put health insurance on the 
     national agenda for the next three years.
       In Pennsylvania, State Rep. Allen Kukovich had a bill to 
     expand and enlarge the western Pennsylvania program, 
     financing it with two cents from a 13-cent-a-pack cigarette 
     tax, which added up to $20 million for the program.
       ``I had the only serious health care bill around,'' 
     recalled Kukovich, now a state senator. ``It was languishing, 
     but all of a sudden it moved to the front burner. It passed 
     in five weeks and was signed in 1993.''
       ``We had this Caring Program in western Pennsylvania 
     providing primary care only for 6,000 children,'' recalled 
     LaVallee. ``All of a sudden we could provide comprehensive 
     care for 25,000. We got more money in a month from the 
     Commonwealth of Pennsylvania than we got in a year of fund-
     raising. For us that was a dream come true . . . and enabled 
     us to take the next step.
       The program has turned out to be a way station for 
     families, 40 percent of whose children move off the program 
     within a year--largely because their families got jobs. Thus 
     the program becomes a bridge to mainstream coverage.
       That is what happened with Maurine Ceidro, 41, who lives 
     with her three children--Sarah, 11, Jason, 13, and Janean, 
     19--in nearby Greensburg. They were covered by the Caring 
     Program for four years after her husband died in 1992. 
     Although she has a college degree in theology, she was 
     working low-paying, no-benefit jobs: part of a crew cleaning 
     houses and offices after they had been damaged by fire and 
     soot and as a caregiver at a home for disturbed children. 
     Neither provided health insurance for herself or her 
     children.
       She saw a Caring Program brochure advertising free health 
     care for children. ``I thought this was too good to be true. 
     This is not possible,'' she said.
       ``Once I knew we had health care coverage, I could think 
     about steps I have to take, because obviously I was their 
     sole support. If we kept on the way we were going, we would 
     be putting out fires for the rest of our lives. It offered no 
     future.''
       Ceidro went back to school for her master's degree in 
     theology. ``Having health coverage for the children gave me 
     the opportunity to go back to school because I didn't have to 
     worry about any bad mishaps devastating the family,'' she 
     said. Unlike Gavin, she didn't worry about health insurance 
     for herself.
       In January, after her children had been covered for four 
     years, Ceidro started work as director of pastoral care at 
     Jeannette District Memorial Hospital.
       That's how it works. It got us through that really awful 
     period,'' she said. ``But in January I called up and said, `I 
     don't need it any more make room for three new children.' ''
       The Gavins have been in the program for more than three 
     years and it has proved its worth. After three operations at 
     Pittsburgh Children's Hospital, covered by the Caring 
     Program, Philip is behaving like any other rambunctious 6-
     year-old, chasing his older brother Larry, 9, a straight-A 
     student who holds a second-degree red belt in karate.
       ``Without health insurance in no way could I treat Philip 
     as normal, I have a hard time treating him normally now, but 
     I let him go and I bite my nails. To me he is special, but to 
     an insurance company he's just medical bills,'' Gavin said.
       ``When I am sure he is well, then I can figure out what I 
     want to do when I grow up,'' said Gavin, who believes the 
     best thing she can do now is be ``a full-time mom.''
       ``When that happens we won't need insurance from the Caring 
     Program anymore and someone else can get it.''
     
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