Photos by Jeanna Duerscherl | The Roanoke Times

Dana Mabry is a case manager for Roanoke's Child Health Investment Partnership, yet enrollment in the CHIP program would take almost all of her take-home pay. One CHIP executive said none of her employees can afford the program.

A recent raise of $1 an hour has placed Don and Michelle Boyd's two youngest children, including 4-year-old Mary, beyond the range of the State Children's Health Insurance Program. They can't afford other insurance.

As a school nurse in Roanoke County schools, Leigh Anne Duncan will need to apply for FAMIS coverage when her husband moves to part-time employment to return to school.

State Children's Health Insurance Program

• Operates in Virginia as Family Access to Medical Insurance Security, or FAMIS
• Began during the Clinton administration as an offshoot of welfare reform — to help people returning to the work force insure their children
• Congress approved a $35 billion expansion of the program (HR 976) to extend coverage to 3.8 million additional uninsured children. The legislation would increase enrollment in the health program to 10 million from the current 6.2 million.
• The bill passed with bipartisan support in both houses, but President Bush vetoed it Oct. 3.
• On Friday, the House approved a revised children's health bill but fell short of a veto-proof majority.
• Opponents claim the bill goes too far toward covering middle-class children and illegal immigrants instead of poor children.
• Bush has said the bill would encourage people to drop private insurance and enroll their children in government health programs and that a 61-cent increase in the federal tobacco tax would not raise enough money to pay for the SCHIP expansion.
• Children's health advocates say the expansion is necessary to cover working-class parents who can't afford or don't have access to private insurance for their kids.
• U.S. Rep. Rick Boucher, D-Abingdon, voted for the bill while Reps. Virgil Goode, R-Rocky Mount, and Bob Goodlatte, R-Roanoke, voted against it. Sens. Jim Webb (D) and John Warner (R) supported the bill.
• Today at 1:30 p.m., Webb will visit New Horizons Healthcare for a tour and talks with health professionals about the challenges community health centers face. He'll also discuss the importance of funding these centers and programs such as State Children's Health Insurance Programs.

Michelle Boyd was thrilled when her mechanic husband, Don, came home from work recently and announced he'd gotten a $1-an-hour raise.

But when the Montgomery County couple sat down to review their budget, they quickly realized that his new salary -- $43,160 -- would mean their youngest two children would no longer qualify for the federal insurance program designed for children of the working class.

Don Boyd now earns $1,860 a year too much.

The Boyds had the chance to cover the children through Don's employer-offered insurance.

"But if we took that, then we couldn't afford to pay our car payment, and even buying food would be a struggle," Michelle Boyd said.

Their predicament is one Congress had hoped to address when it recently passed a $35 billion increase in the State Children's Health Insurance Program -- a bill President Bush vetoed Oct. 3.

The expansion would have provided coverage for an additional 3.8 million uninsured children, including the Boyds' 4- and 10-year-old daughters.

But Bush and some Republican leaders, including U.S. Reps. Bob Goodlatte and Virgil Goode, argued that the expansion would help middle-class families and illegal immigrants rather than poor children.

Michelle Boyd discussed her plight last week with Radford social worker Rhonda Seltz, a longtime outreach worker for Virginia's version of the SCHIP program, called Family Access to Medical Insurance Security, or FAMIS.

Seltz regularly fields calls from parents -- including police officers, teachers and school nurses -- struggling to buy health insurance for their children.

"It bothers me when people think these families can truly afford insurance," Seltz said. "I work with them every day, and they are humiliated to even apply for these programs. I have one police officer who had to ask for a cut in pay and a demotion in order to get his wife's pregnancy covered" by the FAMIS program for mothers-to-be.

"There's a whole new uninsured population out there, and these are the people the SCHIP program is supposed to be targeting."

Can't afford insurance

Who are the new uninsured?

They're the children of that police officer -- a man who cracked several ribs trying to break into Virginia Tech's Norris Hall during the April 16 shootings.

They're the children of Roanoke County school nurse Leigh Anne Duncan.

They're the children of Dana Mabry, a 26-year-old case manager for Roanoke's Child Health Investment Partnership and a single mom of two. Mabry brings home $779 every two weeks. After she pays her bills, she has $120 left to buy groceries and gas. "I had to save up just to buy my kids' school pictures," she said.

The employee share of family health coverage through CHIP of Roanoke Valley would cost her $1,338 a month -- almost her entire monthly take-home pay.

"Not one of my employees can afford that," said Robin Haldiman, CHIP's executive director. "What I see as the conundrum is politicians who view 200 or even 300 percent of poverty as being middle class.

"When you factor the real cost of insurance in, the take-home pay barely covers it. So you have people making a choice between food and health insurance, or transportation and health insurance.

"And what's going to go is health insurance."

In the Roanoke Valley, some 6,400 people walk around with no health care coverage at all, according to estimates compiled by the Urban Institute for the Virginia Health Care Foundation. In the New River Valley, that number is 3,000.

These are largely people who earn too much to qualify for FAMIS or Medicaid but who can't afford to buy private or company-sponsored insurance. Roanoke's uninsured rate is 16 percent, three percentage points above the statewide rate.

According to area social workers, the SCHIP program does not serve illegal immigrants -- contrary to arguments made by Goode and Goodlatte. Department of Social Services workers have always been required to check the residency status of people applying for benefits, said Roanoke's DSS director Jane Conlin.

Children of illegal immigrants who are born in the United States are legal citizens and therefore eligible for the program. But "a very small number" of illegal immigrants have even attempted to get SCHIP, she added.

"Illegal immigrants come from countries where contact with the government is negative and maybe even dangerous," Conlin said. "They don't come to us because we're the government, and they're afraid they'll be deported."

'We do all pay'

Who are the new uninsured?

Eileen Lepro knows them well. As executive director of New Horizons Healthcare (formerly Kuumba Health & Wellness Center), Lepro says they tend to be self-employed people whose income fluctuates and people who work for small companies and nonprofits.

Their children typically use health department clinics for immunizations. When they get sick they go to the emergency room, New Horizons (an average sick visit runs about $65) or the Bradley Free Clinic -- if they can get an appointment. They may also be eligible for Project Access, a large network of local physicians who've agreed to treat the working poor at no cost.

More typically, they wait it out.

"What happens outside our doors is what concerns us," Lepro said.

"If they have a serious illness or injury, that means they have to go to specialists or the hospital for procedures that we don't do. And that's going to end up being largely written off by the hospital system or the doctors themselves.

"So we do all pay for that in one way or the other," Lepro added.

"If you can give people the security of having an insurance plan, wouldn't it follow that they would be more apt to use the resources at an earlier and more cost-effective stage?"

Roanoke County Schools nurse Leigh Anne Duncan said she and her husband, Dennis, had to swallow their pride recently when they called to ask about getting FAMIS for their four children.

Duncan's 9 a.m. to 2 p.m. school shift doesn't qualify as full-time, so insurance isn't offered. Her second part-time job -- as an instructor for the College of Health Sciences -- doesn't offer benefits, either.

Right now, the Duncans have family coverage through her husband's employer. But Dennis, a paramedic, recently returned to college full time; he wants to become a physician assistant. In order to excel at school, he's come to realize, he'll eventually have to cut back to part-time work.

A caseworker at CHIP told Leigh Anne they would likely qualify for FAMIS for their children. To insure themselves, they'll pay $200 a month for a private policy.

During a recent work shift at Hidden Valley Middle School, Leigh Anne Duncan had looked at sore throats, checked wounds for possible staph infection and helped one girl who had fainted. So far this year, she's recommended FAMIS to the parents of at least 10 children in her school.

"It's ironic, isn't it?" she said. "But I'm OK with us having to do this [apply for FAMIS] because I feel like this is why we work, this is why we pay taxes.

"We're definitely not taking advantage of the system. We're doing what's best for our family, and it'll enable us to better serve who we work for."