Tuesday, May 13, 2003 | 11:06 a.m.
Sick children have a harder time getting health care in Nevada than in most other states.
Nevada has some of the highest percentages of children without health insurance and has a shortage of pediatricians. The result is that many children don't see a doctor as soon or as often as they should, experts say.
School nurses know all too well that "there are just a lot of students who don't get health care, so parents try to use hospital emergency rooms or schools as their primary care providers," said Diana Taylor, a registered nurse who is an administrative specialist in the Clark County School District's health services department. "Kids will come to school with a fever, coughing and pink eye."
The U.S. Census Bureau estimated in 2001 that 11.2 percent of Nevada children whose families earned $29,256 or less -- twice the amount of the federal poverty level as listed by the government for a family of three that year -- didn't have health insurance. That was the seventh highest percentage in the nation, which averaged 7.9 percent uninsured.
In another 2001 study, the Henry J. Kaiser Family Foundation of Menlo Park, Calif., tabbed Nevada as the state with the sixth highest percentage of uninsured children -- 16 percent compared with a 12 percent national average.
The Great Basin Primary Care Association in Carson City, an advocacy group for Nevada community health centers, reported last year that there were 112,259 uninsured children in Nevada as of July, including 82,137 in Clark County. Great Basin estimated that 20 percent of county children up to age 4 had no insurance and that more than 17 percent of all other Southern Nevada children also weren't covered.
Valley High School officials were so concerned with the number of uninsured students at their school that they convinced the Clark County Health District last year to open a health clinic on campus, staffed by county nurses. That clinic, which also serves Valley's feeder middle and elementary schools, and one at Roy Martin Middle School are the first of their kind in the Las Vegas Valley.
Valley Assistant Principal Trent Day said the clinic has been a big success -- in one month alone it provided immunizations to more than 100 students.
"We have a lot of students who are new to the community," and their parents haven't found jobs yet, Day said. "We also have a lot (of students) from other countries and a lot of students who are homeless."
Day said Valley sought the clinic because many of the children needed social services "so that we could get them into school. If a child isn't healthy, he won't be successful in school."
Lowering the percentage of uninsured children is difficult because of Southern Nevada's transient community, its rapid growth and the nature of its work force, local health officials say.
Mary Coon, Southern Nevada coordinator for the nonprofit Covering Kids and Families, said she runs into problems of transiency as she attempts to locate uninsured children for placement in state-funded health programs for low-income residents such as Nevada Check-Up and Medicaid.
"They move into town so fast that it's hard to keep up with them," Coon said. "And then when they're here for six months they move someplace else. Transiency is an issue and the sheer number of children we are trying to reach is staggering, so it's also a population problem."
The high number of uninsured children is also linked to the number of Nevada employers in the construction, retail sales and gaming industries who either provide no health insurance or cover workers, but not their children, said Cynthia Bunch, a registered nurse and president of the Nevada Nurses Association.
Other employers offer coverage for children, but the premiums are so high that the parents turn it down. Part-time workers also have difficulty obtaining insurance for their children.
Because of these reasons Dr. Raj Chanderraj, past president of the Clark County Medical Society, said he would like to see tax incentives offered to small businesses to get them to provide health coverage for the workers and their families. Chanderraj chairs the Clark County Health Access Consortium, which aims to improve care among low-income residents.
One of the biggest reasons the consortium has found for the lack of health insurance is that most of the employers in Las Vegas are small businesses and many of them cannot offer their people affordable health care, he said.
"And some employers give their employees minimal work hours so they can get away without providing benefits," Chanderraj said.
Children who don't have health coverage and therefore receive inadequate care run the risk of developing more severe health problems later in life, such as asthma, said Fran Courtney, director of clinic and nursing services for the Clark County Health District.
"We have children who weren't adequately diagnosed so they weren't adequately treated," Courtney said. "We see them all the time."
To make matters worse, Southern Nevada lacks pediatricians, according to a University of Nevada School of Medicine study. As of last year the county had 151 pediatricians but should have had 343 based on the size of the population, said Dr. Beverly Neyland, the school's interim pediatrics department chairwoman.
"We have known for a long time that a lot of our pediatric patients are either seen by general practitioners or use emergency rooms for primary care," Neyland said.
But she said it is advantageous for families to have a pediatrician on a long-term basis because such doctors specialize in treating children.
Compounding the problem are other issues as highlighted by these Kaiser Family Foundation statistics:
Charles Duarte, administrator of the Nevada Division of Health Care Financing and Policy, said he wasn't surprised by those rankings because Nevada traditionally has made its Medicaid eligibility standards tougher than most states and hasn't offered the range of health programs found elsewhere.
An example of the wide gap between the number of children who need services and the number who actually receive services occurred in 2001 when only 18,324 of 108,479 Nevada children who were eligible received dental services under Medicaid, according to Duarte's division.
"I guess it's a political decision," Duarte said. "You need general funds and we don't have them. I've got to be appropriated money if I am going to build new programs. There needs to be a revenue base to support these programs."
A solution in peril
A notable exception occurred in 1998, when the state created Nevada Check-Up, a comprehensive health care program for children in families that earn no more than twice the federal poverty level. This year that figure is $30,528 for a family of three.
Coverage also includes dental and vision care, as well as prescription drugs.
Most participants have at least one working parent whose employer doesn't offer health insurance for the employee or the employee's children, or the parent cannot afford the offered coverage. Their children aren't eligible for Medicaid because the family's income is too high.
Single mother Rose Tapalla, a legal secretary in Las Vegas, was picking up her two sons at a day-care school operated by the Nevada Association of Latin Americans when she noticed bulletin board information on Nevada Check-Up.
Like employees of other small companies, Tapalla has employer health coverage for herself but not her children. And although she has received salary increases, she said she could not afford the premiums to cover her children through private insurance. So in 1999 she took the time to complete the Nevada Check-Up questionnaire, which included questions about her income, employment and relevant information about her children.
Within two months Tapalla was able to enroll her children in the program. Today she pays only $100 a year to cover her sons.
"The program is wonderful," Tapalla said. "It's the greatest thing I've ever come across. As a mother of two, it has really eased my mind. Now I know that they can be covered until age 18."
Her sons now get annual checkups and have been fully immunized. They have been able to see specialists -- both were circumcised and the Nevada Check-Up covered the surgeries. Emergency care is also available under the program, as Tapalla discovered on one occasion.
"My youngest son had an extremely high fever and wasn't able to breathe," she said. "I gave him Motrin but it didn't help. At 2 in the morning I rushed him to Desert Springs Hospital and they gave him shots. Without Nevada Check-up I don't think I would have gotten the help I needed for my child.
"Without Nevada Check-Up I would be devastated," Tapalla said. "I would be in the poor house. Either I would be out of money or my kids would be very sick. Without insurance it would take a long time to see a doctor."
Licensed process server Craig Larson of Las Vegas said he enrolled his daughter in Nevada Check-Up because he could not afford to pay the $80-per-paycheck premium that was available under his employer's plan.
If not for Nevada Check-Up, he said he never could have afforded the $3,500 he estimated it would have cost to get his daughter braces to correct a severe overbite. Under the state program, he was not charged for those braces.
"It's the greatest program," Larson said. "What would I do without it? I have absolutely no idea."
By all accounts, Nevada Check-Up has been a major success, with enrollment of 25,687 children as of March. Parents pay up to $200 a year per child for the coverage, and the state and federal governments provided $29 million this fiscal year for the program.
Duarte has asked for $3.9 million in additional funding over the next biennium to help cover a caseload that is projected to reach 31,023 children by 2005. That request was approved by a Senate-Assembly budget committee last week but has yet to win complete legislative approval.
Duarte said projected caseloads would only keep pace with population growth and wouldn't necessarily decrease the number of uninsured children that exists today. And another potential hurdle is that some lawmakers this year have said they either want to slash the program or cap enrollment because of the state's budget crisis.
"Nevada Check-Up has had an impact in reducing the level of uninsured children but the number of uninsured children remains large and is still growing," Duarte said.
And Bunch, of the nurses association, said: "If the economy does not improve, we're likely to see an increase in the number of uninsured children."
That's why Duarte, Bunch and other health officials said it would be a mistake for the state to slash Nevada Check-Up.
"In my opinion Nevada Check-Up is better than a lot of private insurance plans," Bunch said. "Our position is to support full funding for all eligible children."
Taylor said Nevada Check-Up "seems like the most ideal program to me if we can keep it going. We're just wondering how long it will keep going."
Coon, of Covering Kids, said the parents who have enrolled their children in Nevada Check-Up "swear by it."
"They don't know what they would do if it weren't for that because they cannot afford health insurance for their children," she said.
Bookkeeper DeDe Denissan of Las Vegas, who has a boy and a girl enrolled in the program, is one of those parents.
"Insurance is really expensive and I can't afford it," Denissan said. "If I didn't have Nevada Check-Up, my children would have to live without insurance."
To any lawmaker who would dare reduce or eliminate Nevada Check-Up, Larson said: "Obviously they can afford to take their kids to the doctor. If it weren't for Nevada Check-Up, kids would be lined up at University Medical Center, which is already having problems of its own."