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Child Watch® Column: "Hard Times and Child Health Care"

Release Date: June 1, 2007

Marian Wright Edelman

Marc Bostic has the look of someone shaped on the football field and by years of practicing martial arts. He's a handsome, well-educated man who had been the senior executive manager for a construction company. On first impression, one wouldn't suspect that he was anything but the picture of health and success. But appearances can deceive. Six and a half years ago, Marc was in a major auto accident. His back was broken and his sciatic nerve permanently damaged. Today, his left leg is constantly numb below the knee and his mobility is impaired.

Marc had worked since he was a teenager and always thought of himself able to earn enough to provide for his family without his wife having to work outside the home. The accident changed all of that. Marc has a few investments and he gets consulting jobs helping construction start-up companies. But because of his injuries, his employment record has been erratic. He hasn't worked since July 2006, and all the family savings are gone. As a result, Marc, his wife Patti, and their four children are barely able to keep their heads above water financially. The family moved in with Patti's sister after they had to sell their home in the Columbus, Ohio, suburb of Dublin. It got to the point where they couldn't keep up the $1,500 monthly mortgage payments. There were periods when they had to rely on the local food bank.

One of Marc's biggest challenges has been providing health care for his family.  They had been on and off of Ohio's Medicaid health coverage program. Each time they applied, there was some bureaucratic obstacle to overcome. For example, according to the Medicaid guidelines, his educational background qualified him to work at certain specified occupations. In one instance, the Medicaid officials wanted him to supplement the health care assistance he received by unloading trucks, a task he was physically unable to perform. Marc can't lift heavy objects or sit for more than two hours at a time. He can't stand or walk for too long and he needs rest periods.

The health care assistance they received did not cover certain medications the family needed, and Medicaid officials required the family to accept cheaper and less effective generic drugs. In addition, Medicaid's reimbursement schedule did not cover the fees their family doctor or specialists charged for services. Because of their inability to enroll in Medicaid, no one in the family has had health insurance since July 2006. Marc said it was suggested that if he and Patti were to separate until Marc could get disability benefits, Medicaid would provide Patti all the assistance that she needed.

Patti started a new position as a shift supervisor at a local business about three months ago, but since the company has a six-month probation period, she won't be eligible to enroll herself and the children in their insurance plan for another three months. Over that time period, the children will remain uninsured because Patti's salary is over the income limit to enroll them in Medicaid. 

With no health insurance, Marihelen, 2, Elizabeth, 5 and Michael, 10, haven't been seen by a pediatrician for almost a year. Marc and Patti have had to seek out clinics where the two youngest children can get free immunization shots. Michael needs medication to treat his Attention Deficit Hyperactivity Disorder and Tourette's Syndrome. He's acting out in school and having difficulty keeping up academically. Marc's daughter Steffie, 17, has had to stop taking medication for severe menstrual bleeding. Marc pays $150 monthly for his pain medication out-of-pocket. Uninsured and vulnerable, one more serious child illness could push the family over the edge to complete bankruptcy.

Even in families where the main breadwinner hasn't been disabled, it's a constant struggle to provide their children with health coverage. Many working families are in a no-man's-land where they don't earn enough to afford private insurance but make too much to be eligible for Medicaid or the State Children's Health Insurance Program (SCHIP). Up until now, Medicaid and SCHIP have made great strides in providing children with health insurance. But even with their successes, nine million children in America are still without health insurance and millions more are underinsured. Ninety percent of them are in working families.

We have a unique opportunity to take the next logical, achievable and moral step that would guarantee comprehensive health and mental health care to all children and pregnant women. Congress and the President must enact the All Healthy Children Act (H.R. 1688) this year. No child should be denied health care because his or her parents are struggling financially. Protecting our children's health is one of the most important investments we can make for our future.  For more information, please go to www.childrensdefense.org/healthychild.