Journal Issue: Health Insurance for Children Volume 13 Number 1 Spring 2003
What Does It Take to Innovate?
Based on the experiences of these two programs, three elements seem crucial to moving toward a universal health care program for children—bringing together committed leadership and infrastructure, generating diverse community support, and leveraging public and private funding sources.
Bringing Together Committed Leadership and Infrastructure
Both counties have a safety net infrastructure with a public hospital, a network of community health clinics, and leadership that was actively involved in the planning, design, and early implementation phases of their respective programs. The executive director of the Santa Clara County health and hospital system was one of the driving forces behind the initiative and engaged the support of the county board of supervisors for children's access a year before the program was ultimately launched. In King County, a brainstorming session with key health leaders about why increased enrollment was not resulting in better access for children ultimately led to the creation of the KGC program.
Having a publicly financed delivery system probably also facilitated these conversations and action plans, but having the system alone would not have stimulated these initiatives. Counties with the administrative capacity, financial resources, and provider networks experienced in working with low-income communities are more likely to develop these types of innovative expansions. Health, government, and community leaders, working collaboratively and with a steadfast commitment to the larger goal of expanding health access to all children, were the "sparks" that made these programs a reality.
Generating Diverse Community Support
Community leaders and organizations played a catalytic role in developing and advocating for their respective programs. In Santa Clara County, two community groups, the labor-affiliated Working Partnerships USA and the faith-based People Acting in Community Together, championed the goal of 100% coverage for every child living in the county and exercised their political influence to promote this goal with county and city officials. They also mobilized hundreds of residents to testify at public hearings. With the initiative already 18 months underway, both organizations continue to be actively engaged in the program's implementation and evaluation.
In King County, the active leadership of Health Action Plan partners such as the health department and the Washington Health Foundation continues to develop local support for future program expansion. While the role of local stakeholders will certainly differ in every county, capacity to generate the political will to launch a broad-based children's health initiative is crucial.
Leveraging Public and Private Funding Sources
Piecing together a viable funding strategy is another key component to these programs' inception and to their intermediate and long-term survival. Santa Clara and King Counties each managed to strategically access local revenue sources and leverage those dollars in an effective manner. Both programs have developed intermediate financing strategies that access foundation and corporate matching support, build from diverse public–private partnerships, and maximize available city and county revenues.26 In addition, both programs have already begun to strategize about how best to leverage local public and private funding sources to secure sustainable state and federal funding for their children's access programs.