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By Nancy Mccarthy of The Skanner
Published: 22 February 2006

Of Oregon's children who could qualify for privately or publicly funded health care, 25 percent — or 117,000 — are still going without health insurance, according to a survey conducted by a family physician from Oregon Health & Science University.

Conducted by Dr. Jen DeVoe, the survey of low-income families enrolled in Oregon's food stamp program determined that the percentage of children without health insurance has risen from 10.1 percent in 2002 to 12.3 percent in 2004.
"Twenty-five percent of eligible children without coverage is quite a staggering number, especially when they qualify for coverage," DeVoe said. "We have existing programs that we think are covering these children, but they aren't covered. There's a lot of work to be done."

Low-income children most likely to go without health insurance are Hispanic, aged 14 and older and in families whose income approached the higher end of the low-income threshold. In some cases, they had an employed but uninsured parent.

DeVoe conducted the survey in 2005 for the Office for Oregon Health Policy, which develops and analyzes health policy in Oregon. It also serves as the policy-making board for the Oregon Health Plan.

A sample of families enrolled in the Oregon food stamp program with children between the ages of 1 and 19 participated in the study. They were asked what prevented them from applying for publicly financed health insurance and their ability to find health care for their children. The mail-in surveys were returned by parents of 2,681 children.

It was while she was examining a mother at her Gabriel Park office that DeVoe decided to learn more about the problem of uninsured children in Oregon. The woman, who was employed and had health insurance for herself, came to see DeVoe about her bronchitis. She also asked DeVoe to examine her son, who was ill but who had no insurance. The woman's employer had stopped paying for employees' children.

"She told me she could no longer afford to cover her son because the cost was more than her net earnings for the month," DeVoe said.

The family physician learned later that the average family in the United States pays more than $9,000 a year for health insurance.

In addition, DeVoe said, "The lower the wage, the more the employee pays on his or her own. The employers they work for offer less benefits and less pay, so the employees pay more for insurance."

The survey also found that:

• Nearly 40 percent of children without health insurance did not visit a doctor's office or health clinic in the past 12 months, compared to 9 percent with insurance;

• Children without health insurance were almost six times more likely than insured children to lack a usual source of care;

• Children without health insurance were three times more likely to be taken to a hospital emergency department or an urgent care clinic for regular care; and

• Only 19 percent of uninsured children received all of the dental care they needed, compared with 58 percent of privately insured children.

About 21 percent of the parents said they thought their child wasn't eligible for the Oregon Health Plan because the household income was too high. Another 20 percent of parents said the person whose private insurance covered the child was no longer eligible for coverage, due to job changes or reduced job time.

Nearly 17 percent said the family couldn't afford to pay foremployer-sponsored health insurance premiums. One-third of parents said they found it difficult to apply for the Oregon Health Plan or they had missed the deadline to renew the plan, which requires re-enrollment every six months.

The survey concluded that the Oregon Health Plan renewal process needs to be simplified and the enrollment period should be extended to 12 months from the current six-month process.

The rising cost of health care also needs to be examined, DeVoe said. Something must be done to lower the cost of coverage for families who have access to employer-provided insurance but just can't afford it, she added.

OregonGov.Ted Kulongoski called the lack of access to adequate health care a "terrible burden for children."

Kulongoski said his goal during the next year is to "ensure that every child in Oregon, up to the age of 19, has their basic medical care needs met."

"My focus is on enrolling all eligible kids and keeping them enrolled through a plan that is also affordable for low-income parents whose incomes are too high to qualify for subsidized state and federal programs," he said.

Health care costs became an issue recently when former Gov. John Kitzhaber considered joining the gubernatorial race for next November's election. Instead of running for election, however, Kitzhaber, who created the Oregon Health Plan when he was a state senator, decided instead to focus his energies on revamping health care policies in the United States, starting with Oregon.

"This is a pending crisis of huge proportions, and it demands the immediate serious and bipartisan attention of the United States Congress," Kitzhaber said in a speech in January. "But it is not going to happen without pressure from the inside — and that is where we come in. Oregon has offered national leadership on this issue in the past and it is time for us to do so again."

Kitzhaber estimated that there are over 600,000 Oregonians who fall into the gap between those who receive private insurance and those who fail to be eligible for publicly funded insurance, such as Medicare or Medicaid or who are unable to obtain coverage through an employer.

Kitzhaber has organized the"Archimedes Movement" to address health care coverage; the Web site is www.ArchimedesMovement.org. The Greek mathematician Archimedes found a way to measure the areas and volumes of objects that are irregularly shaped. Kitzhaber quotes him: "Give me a lever and a place to stand and I can move the earth."

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