N.C. kids lag in medical coverage

An advocacy group's findings rank the state sixth in the number of children who don't have health insurance

Even before the economy tanked this year, the number of uninsured children in North Carolina was rising by the thousands, ranking the state No. 6 in the nation for the number of children who lack health insurance coverage.

And most of the children -- nearly 300,000 -- lived with parents who held jobs.

The findings, released Thursday by the advocacy group Families USA and using data from the U.S. Census Bureau, raise troubling issues about how and when children see doctors, said Dr. David Tayloe Jr., a pediatrician from Goldsboro and president of the American Academy of Pediatrics.

"We've seen children with appendicitis and brain tumors wait for care because they didn't have insurance," Tayloe said. When that happens, he said, children suffer needlessly from diseases that can often be easily treated if they're caught early. In addition, the cost of care skyrockets.

Many parents are unaware that their children are eligible for coverage. Nearly two-thirds of the children who don't have insurance in North Carolina could qualify for coverage under Medicaid or the state's Child Health Insurance Program, which goes by the name N.C. Health Choice. Medicaid is the federal government's insurance for the poor; Health Choice, funded with federal and state tax dollars, is available to low-income families who make more money than Medicaid allows.

Penella Washington, chief executive officer of Wake Health Services Inc., said she recently talked with a mother of three who arrived at the agency's community health clinic seeking vaccinations for her daughter, who was entering public schools.

"She had a baby in a carrier, a toddler in her arms, a child about 5 hanging on to the back of her shirt," Washington said. "In the course of the visit, we realized the baby, the toddler and the other child were all eligible for Medicaid, and the mother had no idea that all of her children could be brought up to date on shots and physicals. All this mother knew was this one child needed shots to get into school, but we could wrap our arms around all these kids and get them all care."

Washington said that scene plays out too frequently at the agency's pediatric clinics, which last year saw 17,421 patients, including 4,776 who had no insurance. She said the number of uninsured patients would "absolutely" spike this year. Through July, the organization was on pace for a 14 percent increase in uninsured patients.

What the agency is seeing this year, Washington said, is parents losing employer-based health coverage, either through job layoffs or because they can't afford their share of the monthly charge for a family policy. Others buy a cheaper plan through their employers, covering only catastrophic events. That leaves them vulnerable when their children get the flu or sprain an ankle.

"They're not getting primary care, where they could prevent the hospitalizations," Washington said. The flaw in that gamble, she said, is the higher cost. "It's pay me now, or pay me later."

Tayloe, the Goldsboro pediatrician, warned that the government is under greater pressure to help families who need assistance, even as tax revenue declines in the tightening economy. Funding for N.C. Health Choice, along with programs in other states, is scheduled to expire next year, and advocates such as Families USA are pressing for more money. An effort to extend the program failed in 2007, when President Bush vetoed a bill to expand coverage and Congress was unable to override the veto.

Without more money, Tayloe and others said, the programs would have to deny coverage for children during a time when help is most needed.

"We just can't stand to have a freeze" in enrollments for Health Choice, Tayloe said. He said a freeze would create a situation in which so many patients were unable to pay, doctors would have to turn them away. "That's awful."