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APHA Scientific Session and Event Listing

Recorded presentation

Michael Cousineau, DrPH¹, Gregory Stevens, PhD¹, and Kyoko Rice². (1) Family and Community Medicine, University of Southern California, 1000 S. Fremont Ave, Alhambra, CA 91803, (626) 457-6678, cousinea@usc.edu, (2) Division of Community Health, University of Southern California, 1000 S. Fremont Ave, Building A7, Room 7410, Alhambra, CA 91803

Context: Many of the largest counties in California are pursuing the goal of universal coverage for children. With an estimated 782,000 children uninsured in California in 2003--many of whom are undocumented residents--counties have independently created publicly and privately financed health insurance products known as Healthy Kids to cover uninsured children in low-income families ineligible for other existing public programs.

Objective: To describe changes in the financing and sustainability of Healthy Kids programs across the state.

Study Design: Semi-structured longitudinal initial and follow-up interviews (1 year apart) with program representatives (n=33).

Main Outcome Measures: Reported financing amounts and allocations to premiums and outreach/enrollment; and three measures of sustainability including the duration of the committed dollars, stability of funding sources, and diversity of funders.

Results: Since their inception Healthy Kids programs have raised nearly $350 million. Most of the dollars (84%) directly subsidize premiums, with the remainder used for planning, administration and outreach/enrollment. First 5 organizations (county-based tobacco tax-funded organizations directed to support programs for young children) have been the main financial supporter, accounting for 42% of program funding statewide. While funding from First 5 organizations has enabled most Healthy Kids programs to enroll all eligible children ages 0-5, coalitions report major concerns about sustainability for children ages 6-18. One-third of programs reported not having enough funding to cover the premium costs for a similar number of children for the following fiscal year, a proportion that has increased from the initial interview. Measures of the stability and diversity of funding reveal slightly more positive views of sustainability, but representatives report a great need for more secure funding through a statewide Healthy Kids program.

Conclusion: The steady movement of counties expanding health insurance coverage for children demonstrates how coalitions at a local level can accomplish health policy reform that to date has eluded state and federal government. However, without ongoing financial support for these programs, there are major sustainability issues (especially for children ages 6-18) and some programs may be forced to reduce their enrollments or limit the programs in other ways, reversing the substantial progress that has been made towards universal coverage for children in California.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• Articulate the purpose of the development of children's health initiatives in California.
• Describe the financing mechanisms and factors that contribute to the sustainability of the programs.
• Understand the implications of sustainability of these programs on program enrollment capping, benefits reductions, and potential impacts on child health.

Keywords: Financing, Health Insurance

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation