Hush little baby, don't get sick.

• Author: Gordon, Dianna
• Position: Children and health care reform - Includes related article

With many working poor families unable to afford a doctor for their children, some states have taken the lead in this special area of health care.

It's the pediatrician of forced choice for those who don't have a family doctor. Ear infections, sore throats and coughs are as common in today's hospital emergency rooms as chest pain, head injuries, gunshot wounds and overdoses.

It's symptomatic of the nation's most pressing problem--a lack of affordable health insurance that would allow those parents who don't qualify for Medicaid to take coughing children to a family doctor instead of a local emergency room. In all, Americans made 50 million visits, many for children's ailments, to hospital emergency rooms in 1992 for nonemergency medical treatment.

Those costs are passed on to other patients and to insurance companies as hospitals and medical centers attempt to recoup uncompensated emergency costs.

"Emergency rooms have become the family doctor for too many Americans," noted U.S. Health and Human Services Secretary Donna Shalala. "Emergency rooms are not intended to deliver routine medical care; patients don't get the timely, preventive services. And the cost is three times higher than visits to a doctor's office."

Another regular service a family doctor provides is vaccinating children against disease. But there were 2,237 measles cases in the United States in 1992 and 160 cases of rubella, both diseases that can be easily prevented by immunizations given in early childhood. And the danger of allowing rubella to spread is that it causes serious birth defects if pregnant women are exposed to it. Because there are some parents who are unaware that vaccinations are necessary, some who don't find the time to take their children in for immunization and some who cannot afford it, there were about 9,000 cases of contagious diseases in the United States in 1992 that would never have struck had all children been immunized. (A little less than half, 40 percent, of all American preschoolers are not fully immunized.)

As Washington continues to debate national health care reform, some states have come up with prescriptions for what ails uninsured children and pregnant women and are helping to keep them from slipping through the gaps in medical care.

Pennsylvania Insures Children

Pennsylvania, for example, subsidizes medical insurance for children of low-income families. Those with an income between 185 percent and 235 percent of the federal poverty level pay half the cost of coverage. The plan, financed by a 2-cent-per-pack tax on cigarettes, covers about 30,000 children and offers preventive as well as general medical care.

"This program was designed to help children," says Diana Donovan, Pennsylvania Department of Insurance. "It reaches children from families who have an income that disqualifies them from any other medical assistance but who still can't afford insurance."

The state contracts with insurers for the program. This year, it was able to offer four Blue Cross plans and also had contracts with U.S. Health Care and Geisinger, two health maintenance organizations (HMOs).

New York, Connecticut, Hawaii and Massachusetts also subsidize private insurance coverage for low-income children.

Florida Keeps Kids Healthy

In a pilot project, the Florida Healthy Kids Corporation provides health insurance coverage through participating public schools with families paying a sliding fee based on income. Healthy Kids covers children and...