Use of aid for kids’ health care is down

CARSON CITY -- At a time when Nevada has the highest uninsured rate for children in the nation, enrollment is down in a state program in which some poor children could secure free medical care.

A Census Bureau study released Tuesday found that one of every five Nevada children lacks health insurance. At the same time, enrollment in Nevada Check Up has dropped more than 10 percent from a year ago. Just 21,578 children were enrolled as of Wednesday, down 2,700 from September 2008.

Officials are puzzled as to why parents whose children are eligible for the program wouldn't be taking advantage of it. One local think tank said that states with large numbers of Hispanics -- the minority with the largest uninsured rate at nearly 31 percent -- fare poorly overall in insuring kids. And one union official said if there were more union gaming properties in Northern Nevada, the state's numbers would be better.

Elizabeth Aiello, deputy director of the state Division of Health Care Financing and Policy, said officials aren't quite sure what's behind the drop in Nevada Check Up enrollees.

"Part of the problem is people aren't aware of the program. Also, a lot of people don't want to be involved in government programs," she said.

The enrollment is nearly 50,000 less than the number Aiello's boss, Charles Duarte, estimated at legislative hearings in February would be eligible for free care.

The census study found about 120,000 Nevada children -- or 20.2 percent of those under age 18 -- now lack health insurance. That uninsured rate is more than double the national 9.9 percent average.

For Nevadans of all ages, the uninsured rate in 2008 was 21.3 percent, third worst behind Texas and New Mexico. The national uninsured rate was 15.4 percent.

Although Nevada Check Up enrollment is down, a record 222,000 Nevadans of all ages are now enrolled in Medicaid, a $2.8 billion federal-state free health care program.

The Medicaid enrollment figure already is higher than what Duarte estimated for July 1, 2010, when the Legislature approved his budget in June. He said last week the state may need to find $37 million in additional revenue to cover higher Medicaid costs.

Under state regulations, children whose families are eligible for Medicaid must enroll in that program even if they have been Nevada Check Up participants.

Geoff Lawrence, an analyst with the Nevada Public Research Institute, a conservative think tank in Las Vegas, noted the three states with the highest uninsured rates have large Hispanic populations.

The Census Bureau study found that 30.7 percent of Hispanics in the United States last year were uninsured, the highest percentage of any ethnic group. Just over 25 percent of Nevadans are Hispanic.

Lawrence estimates there are now about 8 million illegal immigrants in the United States. He said the federal government includes them in counting uninsured and that may inflate the uninsured rates in states with large Hispanic populations. Non-citizens are not eligible for federal or state medical care programs.

Under state regulations, children cannot be enrolled in Nevada Check Up if their family income is more than 200 percent of the federally determined poverty level -- which would come to slightly more than $29,000 a year for a family of two. Medicaid has stricter requirements, generally no more than 100 percent of the poverty level.

But Lawrence said at least seven states allow people to enroll in Check Up programs if their incomes are 300 percent of the poverty level.

Because of Nevada's stricter rules, the number of uninsured is higher here, he added.

Nancy Whitman, director of Nevada Covering Kids & Families, said for years Nevada traditionally has ranked poorly for insuring its children. The recession and record high unemployment have just made it worse, she said.

"We are seeing a large number of people today who have never been without health care for their children," she said. "Now they are without a job and they don't know about Nevada Check Up or Medicaid."

Whitman estimates there are 30,000 students in the Clark County School District without insurance. Her organization is trying to educate parents on how they can apply for assistance by showing up at parents' nights and other school functions.

But Danny Thompson, secretary-treasurer of the Nevada AFL-CIO, offered another reason for Nevada's high uninsured rate -- the lack of unionized service industry workers in Northern Nevada.

"Every employee I represent has health insurance, along with all their family members," Thompson said.

But he added only two Reno hotel-casinos -- Circus Circus and the Grand Sierra -- are unionized, and most others do not offer their employees health insurance.

"That is a direct indication as to why the number of uninsured is so high," Thompson said.

Besides the information on the uninsured, the census study also found other unique factors about Nevada.

For one, it has the highest percentage of service workers and the lowest percentage of professional workers of any state.

Slightly more than 25 percent of Nevadans work in service industry jobs compared with the 17.1 percent national average.

Just 14.8 percent of Nevadans work in professional jobs, well below the 20.9 percent national average.

Incomes in Nevada, however, still were above the national medians in 2008, according to the census study, even though they were down about $800 from the previous year.

The median income in the state was $56,114, $4,000 more than the national median.

But the study found even 8.2 percent of people earning more than $75,000 a year are uninsured.

Whitman said she hears all the time from parents who simply cannot afford the cost of health insurance.

"I talked to a mother who was paying for insurance for her three kids. It cost her more than $500 a month. Then she lost her job."

Contact Capital Bureau Chief Ed Vogel at evogel@reviewjournal.com or 775-687-3901.