Score Card on Kids' Health Care Ranks California 44th

California does poorly by its children when it comes to health care, ranking 44th among the states for a slew of indicators, according to a survey released today by a national health care foundation.

“State Scorecard on Child Health System Performance, 2011” takes a state-by-state look at how well the health care system serves kids, looking at 20 indicators, including insurance coverage, affordability of care and access to treatment. Massachusetts ranks first.

Many states have made strides over the last decade in increasing the number of kids and their parents who have health insurance and care—especially in the last few years of recession, when job loss has translated into health-insurance loss. And that coverage pays off in better health prospects for kids.

But California, relative to other states, has “much room for improvement” when it comes to providing access to care for all children, says survey co-author Sabrina How, of the Commonwealth Fund.

“The reason California ranked so low is that you have high uninsured rates for children--about 11 percent of children,” How said. “When you compare that to the national average it is well below and much higher than Massachusetts, where there is universal coverage.”

Among the ratings are indicators for prevention and treatment, such as the percentage of children who have received recommended vaccines. For California’s kids, it was just over 78 percent in 2009, compared to 84 percent for Iowa, the top-ranked state on that measure.

The scorecard also compares the numbers of children who have a consistent medical provider—or medical home. Just 50 percent of California kids have one, compared to top-ranked state New Hampshire, where 69 percent of kids have a medical home.

Nationally, 8.6 percent of kids up to 18 years are without any health insurance. But that number would likely be far worse if not for the Child Health Insurance Program (CHIP), a federal-state health program launched in 1997. Since the economy began its freefall in 2007, CHIP has been a bulwark against more kids losing health care, How said.

“In such a hard time, children were able to hang on to their coverage, while their parents have lost theirs,” she said.

In California, CHIP is called Healthy Families and is funded by the state and the federal government. But state funding for it was targeted for chopping by former Gov. Arnold Schwarzenegger in the last two budget cycles, and it is once again being considered for cuts by legislators today.

California’s low ranking on the child health score card was no surprise to Dr. Claire Brindis, professor of pediatric medicine and director of the Philip R. Lee Institute for Health Policy Studies at UCSF. There is no simple answer to improving children’s access to good care in California, she said.

“Partly, we have a very complex state. One of eight children in this country lives in California,” she said. Many are children of immigrants, who are themselves uninsured and have little or no access to regular health care, Brindis said. And for undocumented immigrants, fear of deportation may keep them from getting health care for their kids, even if they are U.S.-born. Non-citizen’s are not eligible for Healthy Families.

“We have families with one child born here and one child born in Mexico,” Brindis said, “and parents have a ‘Sophie’s choice.’ Which child do they bring for health care? How can they choose one child to have better access?”

Eligibility for Healthy Families coverage is no guarantee that children will get care, though. Brindis said that among the hundreds of thousands who would qualify based on their low incomes, simple lack of knowledge about the program is the first hurdle. And lack of providers is another hurdle to care.

“There are counties with insufficient numbers of pediatricians, so that even having knowledge about Healthy Families program doesn’t mean children will have health care,” Brindis said.

Jeanie Esajian, spokesperson for the state's Managed Risk Medical Insurance Board, disputed the survey's methodology and findings on California. In an e-mail response to request for comment, she said that the survey's data set did not correlate with similar state-generated reports for the same time frame.

The child health scorecard was released on the second anniversary of Congress’s reauthorization of CHIP, researcher How said, in a nod to the importance of the program in improving children’s health prospects.

“The purpose of the report is as a tool to motivate states to say, ‘Wow, we thought we were doing so great but we aren’t compared to other states,” How said. “A lot can be done at the community level, but you need state leadership.”