Aching for health coverage

By ALISA ULFERTS
Published July 5, 2004

TALLAHASSEE - It was after the birth of Antoinette Rosado's second child that the pain began.

It started in her lower back, a deep tissue ache that left her unable to sit or stand for long. Soon it radiated out to her hip joints, then to her knees, shoulders, elbows and hands. With the pain came waves of fatigue so overwhelming they sent Rosado to bed at all hours.

Diagnosis: fibromyalgia, a painful and often debilitating condition.

Rosado, a single St. Petersburg mom, had to quit her job as a title clerk with the Pinellas County Tax Collector's Office and go on disability. When she left, she lost health care coverage for her two children, Dominic, 5, and Angelina, 3.

Dominic has asthma, and Rosado applied in May to cover him and his sister through KidCare, a popular, state-subsidized insurance program for low-income families.

But lawmakers have capped the number of children allowed in the program. This spring they did away with the program's waiting list - a political liability in an election year - and replaced it with up to two open enrollment periods a year. The first enrollment period was supposed to be in September, but lawmakers changed it to January. Now, state officials say, it could be even later. Those program changes, plus others, went into effect Thursday.

That leaves mothers such as Rosado worrying about how long their kids will go without insurance. And because the state no longer keeps a waiting list, Rosado will fight with thousands of other parents for a limited number of slots.

"Fibromyalgia is exacerbated by stress, and it's already stressful enough being the single parent of a 5-year-old and a 3-year-old," said Rosado, 41.

"You can't help but wonder if they're hanging off the monkey bars and are going to break their arm," Rosado said.

In the weeks preceding this spring's legislative session, lawmakers watched as thousands of kids piled up on a waiting list to get into KidCare. Alarmed that the numbers of families seeking coverage could overwhelm the program, lawmakers tightened the restrictions and limited the program to those families who had no access to private insurance. They later allowed in families who have access to health insurance but would have to pay more than 5 percent of their income for it.

Legislative leaders delivered the bill to Gov. Jeb Bush's desk in the first week of the session without hearing it in a single health care committee and with only a few minutes of public testimony. Some children's advocacy groups in the state, including the Florida PTA and the March of Dimes, opposed the bill, saying more time was needed to consider how families would be affected.

Original estimates suggested as many as 20,000 kids could lose coverage. But program executive director Rose Naff said she has found fewer than 1 percent of the 340,000 kids on the program could lose coverage under the changes.

Roughly a third of the families on the program are employed in the private sector and are, in theory, eligible for employer-based insurance. But for most families, adding children to their insurance plan would cost more than 5 percent of their income. That keeps them in the program - though at almost five times the regular $20 a month premium costs - under the safety valve measure lawmakers built into the new law.

"I have scoured our database. I have called employers. I have not been able to find a single family that would be adversely affected," Naff said.

But that doesn't help those who must wait until at least January for a shot at enrolling their kids in the program, and it could be longer.

State officials decided Friday to automatically move kids who no longer are eligible for certain Medicaid programs into KidCare if they qualify. That's good news for those families, but it could affect whether there is enough money for the state to hold its open enrollment period in January. Naff said KidCare is going ahead with plans to hold the January open enrollment, but she said there is no guarantee that families won't have to wait until September 2005.

Health care advocates and some Democrats in the Legislature say the solution is easy: Lawmakers need to set aside more money for the program.

"Just because we have no waiting list doesn't mean we don't have people waiting," said Rep. Loranne Ausley, a Tallahassee Democrat who has pushed for more money for KidCare.

Other advocates said the enrollment freeze - coupled with the new restrictions on proof of no other source of private insurance - have turned Florida's program from one of the most inclusive in the nation to one of the most restrictive.

"The things that made Florida's program a model for the nation aren't true anymore," said Tallahassee health care advocate Karen Woodall.

Donnieta Ramos of Holiday agrees.

Ramos, 27, is waiting to get KidCare for her son. All three of her sons have asthma, but Ramos' greatest concern is middle son Michael, who is 3. His older brother Cameron Rann, 6, is covered by regular Medicaid because he has a different father and is considered a disadvantaged child. The baby, 7-month-old Matthew, is covered by regular Medicaid until he turns 1. But Michael has no insurance and his asthma is so severe that Ramos has been giving him some of the baby's medicine. But it's not enough.

"The baby's been sick three weeks of the month his whole life," Ramos said.

Ramos' husband, A.J., 27, is a disabled veteran who cannot care for the children on his own. Ramos stays home to care for him and the children. She said she can barely wait until January to get Michael covered, and shudders to think it might take longer.

"Michael has a hard time breathing, especially when he gets sick and in really humid weather," said Ramos, who asked the state for help. "They said to call back in August."

[Last modified July 4, 2004, 23:47:25]