As America's political battle over health care for adults rages, Florida's low-cost health insurance program for children quietly grows.
This spring, Florida surpassed 2 million participants in Florida KidCare, a collection of government programs that partially or completely cover preventive and acute health care for state residents age 19 and younger.
Family income dictates whether applicants' children enroll in the programs such as Medicaid, for the very poor, or Medikids or Healthy Kids, modified plans that charge a monthly premium ranging from $15 to $196 per child.
Largo resident Cindy McNulty works full time but her employer can't offer private insurance she can afford. She goes without insurance and pays Healthy Kids $133 a month so her 16-year-old son, Sean Jones, can see a doctor regularly and get an affordable prescription for his asthma.
Without Healthy Kids, McNulty would be paying $900 a month in premiums for the two of them. Instead, this "full pay" Healthy Kids option allows her son to be healthy enough to practice martial arts and play football at Dixie Hollins High School.
"If I didn't, I'm sure we would have been at the hospital emergency room" for her son's asthma, she said.
Most of those applying for KidCare are parents who have lost jobs or make just less than 133 percent of the federal poverty level. Those children are completely covered under Medicaid, which in Florida has seen enrollment jump since the recession, from nearly 1.4 million in 2009 to 1.7 million statewide in June.
But the numbers continue to rise as well for families making more and qualifying for Healthy Kids. Those include working families without access to private insurance or, like McNulty, can't afford monthly premiums, said Melanie Hall, executive director of The Kids Healthcare Foundation, a Tampa non-profit advocacy group.
"They don't have the resources to pay for it anymore," she said.
Statewide, Healthy Kids enrollment has increased from 198,092 in 2009 to 233,606 in June. The rise is noticeable in Hillsborough, Pasco and Pinellas counties, where between 2009 and June it rose from 21,793 to 25,792.
"There are a lot of families who never realize this was available and they are forgoing prescriptions and appointments and dental treatments," said Jodi Ray, project director of Florida Covering Kids & Families at the University of South Florida.
Unlike Medicaid, which is paid for by a combination of state and federal money, Healthy Kids depends on premiums and an annual allocation from the Florida Legislature. In 2012, the program's budget is $319 million, according to state Healthy Kids data.
Traditionally, government views childhood health insurance different from plans for adults, the core group affected by the national Affordable Care Act, of which parts were upheld last month by the U.S. Supreme Court.
Chronic disease and aging-related illness are at the heart of adult health care, while prevention and monitoring a young body's development garner most attention. Children kept healthy end up being healthier adults, Hall said.
"You have to chart (a child's growth) and stay on top of it rather than what you do for adults," she said.
The U.S. Department of Health and Human Services has spent the past year trying to increase the number of children covered by some form of insurance. In 2011, an estimated 4.3 million – including 381,000 children in Florida – were eligible for subsidized health insurance but not enrolled.
The Department of Children and Families handles all applications for KidCare insurance. It's a complicated, bureaucratic experience, administered under stringent guidelines.
Tampa-based WellCare of Florida announced Friday it was awarded the contract to administer Healthy Kids plan for 65 of the state's 67 counties. It has been managing plans in at least some counties since 2003.
In general, plans available depend on family income and a child's needs. For example:
Despite its appeal, there are downsides to Healthy Kids insurance. Not all pediatricians and specialists accept the insurance. Parents interested in enrolling should first check with their existing doctor to see if they take it, similar to when they switch private insurance plans.
Hall says she doesn't expect Healthy Kids enrollment to slow down anytime soon, and she expects no significant short-term changes from enacting the Affordable Care Act.
"It's much better to pay $20 a month and have access to primary care," she said.