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Foster Care for Kids Whose Parents Won't Pay More to Take Them to the Doctor?

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Last week, state Sen. Greg Brophy (R-Wray) got on conservative radio and said parents of poor kids 1) use air conditioning, 2) smoke cigarettes, and 3) play Lotto, and 4) therefore they should pay more for their children's state-subsidized medical care.

KOA's Mike Rosen didn't press Brophy on whether he thinks kids in poverty won't get medical treatment under his proposal. So I called and asked Brophy to find out.

I told him, let's assume you're right, that some number of people in poverty could come up with more money for their kids' health insurance.

But is Brophy willing to risk that some parents, not all of them, won't pay the extra dough, and some number of our poorest kids will go untreated, get sick, and who knows what else will happen to them?

"I try to tell the truth and then tell you how I feel about it," he tells me, emphasizing that he believes people "respond to incentives... And I think they will make better choices with their health care, which means, yes, they won't go quite as often. They won't go to the emergency room for a runny nose as often. They will make much better choices with regard to that terribly expensive visit [to the ER]."

I had just spent an evening in the ER because brother, who has health insurance, thought he was having a heart attack (but didn't). It was 3 a.m. and I was thinking, could this be more expensive? So Brophy's point made some visceral sense. On the other hand, what if my brother actually had a heart attack? And what if he was a kid in poverty, without a high copayment, and his parents decided not to take him because of the cost?

So I asked Brophy, what if a child from a poor family doesn't get treated?

"That is terrible by the way, and everybody knows that," he replied. "And I hope that doesn't happen."

I believed Brophy, but still, what if it happens?

"I trust that most of them would," he said. "And I guarantee you that the people who are making their kids suffer for that, are making them suffer in all kinds other ways too... I guess if they are so bad that they refuse to take care of their kids, we do have solutions for that, too, that aren't pleasant.  But it's in the best interest of the children. That's foster care. If they are as bad as you're suggesting, that they just won't take care of their kids.

"I know we can't continue to keep spending as much money as we're spending on Medicaid, because no one has it."

Setting aside the question of whether the world's richest nation doesn't have the money to pay for health insurance for its poorest kids, I did a bit of research and found that Colorado has Medicaid copayments of about $20 for ER visits, and small copayments (around $2-$6) for sick visits. There are variable annual enrollment fees for SCHIP, the federal children's health insurance program, of about $35 for more than two kids. Some states charge more. Alabama charges $100. There are also variable co-pays capped at 5% of income.

Here's Brophy's "back-of-the-envelope" calculation: "The average kid on Medicaid or SCHIP costs the state a little over 2,000 bucks per year.  Let's get from them a $15 or $20 co-pay, which is a third or so of the cost of going to the doctor, and a little co-pay on medicine perhaps, again all as reasonable as you can make it, with participation fee from the SCHIP folks. Back of the envelope, $300 million is savings per year. And it puts us on the path toward sustainability with these programs. "

But broadly speaking, does charging these kinds of co-payments (some of which may not be allowed under federal law) put kids at risk?

"It can be an absolute barrier for some parents," said Adela Flores-Brennan of the Colorado Center on Law and Policy, citing a study showing that a new $6-$20 premium lowered the Oregon's Medicaid rolls by nearly half. "So that becomes cost-shifting, not cost savings, because we're covering them in other ways," Flores-Brennan said. "It also deters the preventative care that keeps people out of the emergency room and going to the doctor and seeking appropriate care."

Over at the Independence Institute, Linda Gorman told me, "We don't have good studies that show that kids don't get good treatment just because they don't have coverage. Don't you dare portray us as saying we don't want kids to have medical care. The question is, what's the best way to do that?"

But should we be experimenting with cost savings on our country's poorest children, when, at best, the debate is about conflicting studies and cost-shifting versus cost-saving, with even Sen. Brophy talking about a potential expansion of social services and foster care.

Why put kids at risk?

"There is a risk," said Gorman. "But how much should we spend? Should we spend 10,000 per kid? I'm willing to have a discussion about the risk."

Okay, sure, but I can think of a lot of other discussions that should happen first.