Thousands of Hawai'i children with no health insurance may soon be eligible for free coverage, as the state attempts to extend its safety net much wider across the Islands.

The Lingle administration is planning to raise income eligibility limits for Quest, the state's health insurance program for the poor, so children from more families would qualify for free healthcare. The administration also is working on substantially reducing the premiums for some middle-income families who now pay $60 a month to get their children into the program.

Democrats in the state Legislature are talking with the Hawai'i Medical Service Association about a plan to offer free coverage to children from families who earn too much money to qualify for Quest but do not have private insurance.

The new plan, while not as comprehensive as Quest, would provide basic primary health and dental care and limited hospital coverage. Generic prescription drugs would be available with a $5 co-payment. It would cost an estimated $4 million a year, which would be split between taxpayers and the HMSA, the state's largest private insurer.

Together, the new coverage proposals by the administration and the Legislature would mean every child in Hawai'i would have access to health insurance.

"It's critical in terms of receiving appropriate preventative care but also for things as essential as school physicals and immunizations," said Paul Strauss, executive director of the Waikiki Health Center, a community clinic where many of the clients are uninsured.

BEYOND THE CLINICS

Strauss said children and their parents can turn to clinics for routine care but can run into trouble if their medical conditions are more complicated or require hospitalization. "They're really caught in an unmanageable situation," he said.

State Rep. Josh Green, a Big Island doctor leading a state healthcare task force, said it is unacceptable for any child in the state to have to go without health insurance.

"We want to make sure that no kid falls through the cracks," said Green, D-6th (Kailua, Keauhou).

Hawai'i has traditionally had among the highest rates of health-insurance coverage in the nation. The Prepaid Health Care Act of 1974 requires companies to provide health insurance for employees who work at least 20 hours a week. The state's job and income growth over the past few years has also led to a drop in the number of uninsured, as more people get insurance through their jobs or can afford to pay on their own.

9% MAY NOT BE COVERED

Tracking the uninsured can be daunting, but as much as 9 percent of the state's population — or about 120,000 people — may lack health insurance, according to the task force. An estimated 16,500 children have no health insurance but about half would qualify for Quest if their parents applied.

The Lingle administration has been aggressive about bringing more children into Quest, which now covers more than 100,000 children, and anticipates thousands more would be eligible under the new income limits. The income threshold for free coverage is now about $44,500 for a family of four, but would increase to about $55,650. The administration also wants to relax premiums for some middle-income families who pay for Quest down to $30 or $15 a month, based on income level.

'GOOD, HEALTHY START'

Quest and a companion Medicaid fee-for-service program for the poor and disabled account for about $1 billion in state and federal money each year. Lillian Koller, the director of the state Department of Human Services, said there is federal money available to help the state cover more children.

"It gives them a good, healthy start on life," Koller said.

Democrats and the HMSA are targeting the estimated 8,000 children who now fall outside of Quest and private insurance. Some of the parents of these children could be self-employed or part-time workers who earn too much for Quest but feel they cannot afford to buy private insurance. Others could be full-time workers who for whatever reason are not being covered, or choose not to add their children, to their health plans at work.

MANY ARE FULL-TIMERS

The task force, in its initial report to the Legislature, found that a sizable number of people who are uninsured are apparently full-time workers who should be covered by their employers under state law.

Parents would be able to enroll children for free in the new plan being developed by Democrats and HMSA even if they get their own medical care from other providers. HMSA now offers a similar plan for $50 a month with about 970 children enrolled.

"It's the Volkswagen, not the Cadillac," said Jennifer Diesman, HMSA's director of government relations. "We just want to ensure that every child in the state has access to basic health coverage."

House and Senate Democratic leaders support the plan in concept and will decide over the session whether to approve the state's share of the program. Green, the only physician in the Legislature, said providing preventative care for children would help reduce healthcare costs in the future.

"We know the reality for people. It's hard out there and we need to help them navigate the healthcare system," Green said. "From my standpoint, it pays for itself tenfold."

Barbara Luksch, the project director for Hawai'i Covering Kids, said when children do not have health insurance their parents often are afraid to let them play sports or get involved in physical activities for fear they might get hurt. She also said children with no insurance are more likely to miss school and have medical conditions such as asthma go untreated, causing unnecessary suffering.

Over the past six years, through extensive outreach to parents and in collaboration with community and state agencies, the group has helped thousands of children enroll in Quest.

"If they don't have a pediatrician to call, they end up in the emergency room," Luksch said.

Reach Derrick DePledge at ddepledge@honoluluadvertiser.com.