High-wire health care

Dewayne and Vicky McIntyre work hard. As a result, they were able to move out of an RV park and into a rental home in Yakima they hope to buy.

But the McIntyres were punished for their work ethic.

When they began earning $48,000 annually two years ago, their daughter lost eligibility for the state Children's Health Insurance Program. The cutoff for a family of three is $44,000.

The McIntyres' prospects for health coverage for their daughter, who has a chronic lung condition, should improve in January. But longer term, her health care is bound up with the state's looming budget crisis.

Eight-year-old Sarah McIntyre was born with cysts on her lung and a hole in her heart. She's had surgery to correct both but suffers from bronchial asthma that requires inhalers and as much as $800 in prescription medicines a month.

Because of her condition, the McIntyres get some temporary help from another state program for the medically needy. But that program has a catch. To be eligible, they must "spend down" or pay out up to $3,800 every six months.

"It's very hard to know from month to month if we're going to make that spend-down, and the amount is always changing," said Vicky, 41, who works a split shift at a discount department store so she can take Sarah to elementary school in Union Gap and pick her up at the end of the day.

The McIntyres represent working families without a consistent, reliable source of health insurance for their children, according to Teresa Mosqueda, health policy analyst with the Children's Alliance, an advocacy group in Seattle.

"We have this cliff and then you fall off. There's no safety net," Mosqueda said.

The safety net should catch the McIntyres in January, when state law expands children's coverage to 300 percent of the federal poverty rate, which for a family of three will be $52,800.

Known as Apple Health for Kids, the children's insurance plan is a federal-state program for working-class families that can't find -- or can't afford -- private insurance for their kids but aren't poor enough for Medicaid. It's not free: participating families pay monthly premiums ranging from $15 to $45.

Gov. Chris Gregoire pushed the legislation two years ago and stated that her goal was to cover all children up to the age of 19 by 2010.

The federal government pays 65 percent of the tab and the state picks up the rest.

The state Department of Social and Health Services began taking applications for the expanded program last month, and advocates are trying to get the word out to parents to apply now.

An estimated 2,600 children in Yakima, Benton and Franklin counties will be eligible for coverage.

But the state's budget crisis could affect future funding.

While the Legislature funded Apple Health for Kids through June 2009, funding for the next two-year budget that starts July 1 is in question. The decision will be made by legislators who meet next month in Olympia, where an estimated $5.1 billion shortfall awaits them. Gregoire has said the deficit could rise to as much as $6 billion.

Cutting expanded children's health insurance would save the state an estimated $22 million. Opponents of expanded health care are expected to make their case.

"From where I sit, I think it needs to be looked at," said Sen. Curtis King, R-Yakima, referring to continuing coverage at higher income levels.

"I worry that at 300 percent, we are covering a lot of children who already have coverage through their parents," he said.

Gregoire's budget advisers have already put the children's health insurance program on a long list of possible cuts.

In addition to the state of Washington, 10 other states and the District of Columbia have children's health insurance up to 300 percent of poverty.

Recently, Hawaii's Republican administration cut back the state's free, universal health-care coverage for children, citing the expense and budget shortfalls.

A national health-care consumer organization, Families USA, predicts more families will lose employer-sponsored coverage.

"As the economy deteriorates, the number of companies providing family health coverage is going to fall," the group's executive director, Ron Pollack, said in a recent telephone news conference. "We are going to see a significant increase in uninsured children."

The McIntyres wish they could afford private insurance. But the health plan offered by Dewayne's employer, a welding shop, doesn't offer coverage for children, and it would cost Vicky $600 a month to buy insurance through her employer. She and Dewayne go without health insurance.

"If I could afford to buy coverage on the private market, I really would not be doing this. I just want to make sure she has coverage through the winter. That's her hardest time."

* Leah Beth Ward can be reached at 577-7626 or lward@yakimaherald.com.