Reaching the Summit: How California Became the Largest State to Provide Health Coverage to All Kids

By Wendy Lazarus

In 1997, The Children’s Partnership joined with a small group of children’s advocates and supporters and set an audacious goal—securing health coverage for every child in California. With a name that was aspirational, accountable, and determined, we called our effort the “100% Campaign.”

 When our journey began, California had nine million children, and 1.74 million of them (nearly one in five) had no health insurance. The reasons varied from lack of affordable coverage options, to a 28-page application form, to policies that precluded eligibility for most immigrant children.

During this time, the Clinton Administration’s effort to enact health care for all Americans was blocked, and the bipartisan Children’s Health Insurance Program (CHIP) emerged to address the needs of children whose families make too much money to be covered by Medicaid, but cannot afford private insurance. Meanwhile, California was battling a voter-passed initiative (Proposition 187) in the courts that would have denied most public benefits to immigrants without documentation. At this juncture, our campaign knew there would be an uphill climb to this goal.

The 18-year trek included numerous efforts and hard-won, step-by-step progress—a testament to the persistent, at times creative and at times heroic efforts of policymakers and their staff, foundations who stayed the course, health providers, community organizers, and consumer advocates. Beginning in 2001 with a local pilot in Santa Clara County that demonstrated the health and cost benefits of covering all kids, local Children’s Health Initiatives were expanded over time to become available to children in 30 of California’s 58 counties at their peak. A dedicated group of California leaders tried most every tack possible, including a state legislative and budget effort, a tobacco tax measure on the 2006 ballot, and an attempt by Governor Schwarzenegger to enact state health reform. But budget setbacks, tobacco industry opponents, and legislative opponents frustrated the progress.

Amidst these attempts that came close to covering all kids but failed, impressive progress was made over the years. The Healthy Families Program—California’s CHIP—grew to provide subsidized coverage to hundreds of thousands of children in working families; the 28-page application form was replaced by a far shorter one; and Express Lane Eligibility made it easier to enroll large numbers of uninsured children already certified for other income-tested programs like the National School Lunch Program in health coverage programs. The passage of the landmark Affordable Care Act in 2010 opened up coverage options to many more families, but still the job was not complete.

Even with setbacks, we were not defeated, our resolve strengthened with the knowledge that the public was in favor of coverage for all kids, including undocumented immigrants.In 2005, four out of five voters (78 percent) supported a statewide plan to “ensure that every child in California has health insurance,” with more than half (55 percent) saying they “strongly support” it. In 2014, a majority supported expanding existing health care programs to cover all low-income Californians, regardless of immigration status.

After nearly two decades, policymakers’ actions caught up with public support. Last week, a historic budget was signed by Governor Jerry Brown extending health benefits to undocumented children. Now, we can finally say the original goal of securing coverage for 100 percent of California’s children is a practical reality.

Any good advocate will point out that the job isn’t finished as we work to implement these changes and actually enroll children, and to be sure that securing health coverage translates into meaningful access to health care and improved health for children. In addition, it is time for policymakers to step up and support offering affordable coverage for family members as well as children.

But, it is just as important to herald this moment and acknowledge the work of our state leaders and countless others to achieve a goal so important and so right as making sure that every child in the Golden State has a chance to grow up healthy. It is a 100 percent great moment for California and our kids.

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