June 9, 1992 EXTENSIONS OF REMARKS 14013 EXTENSIONS OF REMARKS MIDDLE-CLASS FAMILIES OFTEN pregnant women have kept many children c1s1ons for children-and not always the LACK INSURANCE FOR CHIL- from joining the uninsured, but the ranks right ones-based on 'can I afford to do this DREN'S HEALTH keep swelling. or can't I?' As a result, those children often State and community-funded clinics and don't get care until their illnesses are ad­ preventive-care programs, public health clin­ vanced or complicated, leading to longer re­ HON. FORTNEY PETE STARK ics and hospitals, federally-subsidized com­ coveries "or unfavorable outcomes," he says. OF CALIFORNIA munity and migrant health centers and Doctors at the Lamprey Health Care Clinic IN THE HOUSE OF REPRESENTATIVES other programs provide care for many needy in Newmarket, N.H., report an increase of youth. But often access is limited, the qual­ children visiting the local hospital's emer­ Tuesday, June 9, 1992 ity of care is spotty and some people don't gency room with severe earaches, sore Mr. STARK. Mr. Speaker, I would like to in­ know of the programs. "Kids fall through the throats or asthma after parents tried and cracks," says Anthony T. Hirsch, a Los An­ failed to threat them at home. They're see­ clude in the RECORD at this point a front-page geles pediatrician who chairs the American ing more parents unable to afford a $20 bot­ Wall Street Journal article of June 5, 1992, en­ Academy of Pediatrics' committee on child tle of antibiotics to treat a common ear in­ titled "Middle-Class Families Often Lack Insur­ health financing. fection or the $500 to $1,000 a year for medi­ ance for Children's Health." OVERBOOKED CLINICS cine to control chronic asthma. A common earache left untended can cause It is a moving description of the "Sophie's The nation's 547 nonprofit community Choice" facing so many American families. I hearing loss. Lamprey's doctors are increas­ health centers, which charge fees based on ingly seeing parents who can't afford the note that the article runs the day after the ability to pay, served about six million pa­ House Republicans announced their health re­ antibiotics or don't return for follow-up vis­ tients in 1990, 44 percent of them children. its to make sure infections have healed. The form plan-a plan which would do nothing to But many more were turned away because of health center had begun giving "starter" help any of the families described in this arti­ excessive patient loads. As many as 1.5 mil­ doses of antibiotics to needy parents and dis­ cle. lion people, up to half of them children, are tributing vouchers for free medicine pro­ typically on waiting lists for the tight-budg­ AT RISK: MIDDLE-CLASS FAMILIES OFTEN vided by the maker of one antibiotic. eted centers. LACK INSURANCE FOR CHILDREN'S HEALTH Many parents say they have no choice but Mostly located in rural or poor areas, these (By Cathy Trost) to put off care. In St. Paul, Minn., 11-month­ centers can be few and far between. In Ohio old Allison McCullough's father, Michael, Anne Ritter's husband lost his job with an there are just 11, in Indiana three. New Hampshire has one for the entire state; doc­ lost his $35,000-a-year sales job with a heat­ asbestos abatement company shortly before ing and air-conditioning business last year­ she was due to deliver their second child. tors there were stunned last winter when a and the family's health insurance with it. The Minneapolis couple paid hefty premiums woman showed up in false labor after driving 1 "We could have bought insurance for $375 a to keep his health insurance coverage but fi­ 2h hours across icy mountain roads from month" for the family of five, says her moth­ nally had to drop it. Maine. er, Ruth Ann McCullough. "But when you're "We didn't tell anybody," confides Mrs. In California last winter, amid a heavy trying to decide whether to pay the heat or viral respiratory outbreak, there were wait­ Ritter. "We come from parents who say you insurance, there is no choice." have to have health insurance. It was a hard ing periods of up to 36 hours to get pediatric The McCulloughs say they couldn't afford decision to make." care in county health facilities. "The system all the childhood immunizations needed, so Then came months of painful medical can't meet the demand," says Dr. Hirsch. they kept the baby mostly confined to home choices about their children's health care. Nationally, the health-care safety net last winter. They nixed a weekly play group They put off for six months a $5,000 cleft-lip catches less than a quarter of the 43 million for fear Allison might catch an ear infection, operation on their older child, now three people-including about 17 million children­ and at church they kept her from playing in years old, until they heard about a state pro­ who don't have access to medical care be­ the nursery, where there are "40 kids and 40 gram covering basic medical needs for unin­ cause they lack insurance, live in under­ strains of who knows what," says her moth­ served areas or can't find a doctor who ac­ sured children. And despite a risk of hearing er. loss in his little brother, now 17 months old, cepts Medicaid, says Daniel R. Hawkins Jr. Part of the problem for uninsured children they delayed having ear drainage tubes sur­ of the National Association of Community stems from ignorance about health-care op­ gically inserted for eight months until he Health Centers. tions, especially among the newly poor. The qualified for the state plan. THE EFFECT ON MEASLES McCulloughs, for instance, refused to go on But when the boy needed hospitalizing one Whether uninsured children are necessarily welfare, but learned just recently that they night with severe bronchiolitis, they had no less healthy than other kids isn't well docu­ were still eligible for state medical aid. They choice. The bill was $1,000, and they're slow­ mented, but some research points to a link. also didn't know that public health clinics ly paying it off. Meanwhile, Mr. Ritter has A study in eight counties in California in the give children free immunizations if parents been able to find just temporary jobs with no mid-1980s showed that the probability of a can't afford fees. "No one tells you any of health benefits. bad pregnancy outcome such as infant illness this stuff," says Mrs. McCullough. Allison NOT JUST THE POOR or death was 31 percent greater for women received one set of immunizations at the The Ritter boys are part of a growing pro­ without health insurance, even when income, local public health department at the behest portion of children not covered by private race and other factors were controlled. De­ of a local congressman's office, but her health insurance. And not all are in families clining immunizations of children have been mother assumed she would have to take her of the unemployed. Increasingly, working­ tied to sharp rises in measles and rubella in to a private doctor for the rest. class and lower-middle-income families are recent years. The cost to immunize a child in the first living without insurance. "People in this Many experts believe, and some evidence year of life, says the pediatrics academy, is country think that it's only the poor, but suggests, that inadequate insurance trans­ about $531-too much for the McCulloughs. what has to be drummed home is the fact lates into inadequate medical care. Studies "We were having to borrow money just to that 80% of kids who don't have health insur­ by the University of California at San Fran­ exist," says Mrs. McCullough. Her two other ance have at least one parent who is work­ cisco in the late 1980s showed that children children are enrolled in the state plan for un­ ing," says Democratic Sen. Jay Rockefeller without insurance used fewer medical serv­ insured children, which Allison will be able of West Virginia, who heads the National ices than those with. to join when she turns one. In the meantime, Commission on Children. The problem appears to be worsening, doc­ the McCulloughs got good news this week. Catching these children in America's tors say, based on their observations. Daniel Mr. McCullough finally landed a job with a health safety net is no sure thing. Many fam­ Shea, president of the American Academy of small heating and air-conditioning business, ilies are too strapped to buy private coverage Pediatrics, says, "All around the country and he'll start getting family medical insur­ and too well-off to qualify for publicly fi­ what I hear from pediatricians is that their ance benefits in a month. nanced programs such as Medicaid. Recent families without insurance or who are under­ The health-coverage problem is challeng­ expansions in Medicaid for children and insured are making conscious health-care de- ing assumptions about middle-class life in • This "bullet" symbol identifies statements or insertions which are not spoken by a Member of the Senate on the floor. Matter set in this typeface indicates words inserted or appended, rather than spoken, by a Member of the House on the floor. 14014 EXTENSIONS OF REMARKS June 9, 1992 America. Brenda Doane, a St. Paul mother of in for advice to avoid paying for an office ~o prepare for the festival, they began two, says her family simply can't afford to visit.