No child should ever have to go without the medical treatment they need and deserve. Yet in the U.S. today, millions of children have no health coverage. The most recent Census data shows that in 2008, 7.3 million children in the U.S. lacked health insurance. That was 9.9 percent of all U.S. children. More than two-thirds of the uninsured children lived in two-parent households with at least one full-time, year-round worker.
In 2009, the Kaiser Family Foundation estimated that 9 million U.S. children remained uninsured, even though more than two-thirds of them were eligible for coverage under Medicaid or the Children’s Health Insurance Program (CHIP). Among children who do have coverage thousands of them lack access to health care services that meet the unique developmental needs of kids due to benefit limitations and unaffordable cost sharing requirements. A January 2010 UPI report says that nearly 25 percent of insured children still lack adequate insurance coverage. Factors such as rising health care costs, complicated coverage enrollment and renewal procedures, and a continued decline in employer-based health insurance for families have contributed to these gaps in coverage.
Most Uninsured Children Live in Poverty
Children from low-income families are disproportionately uninsured. According to a May 2009 report by the Center on Children and Families at Georgetown University, 70 percent of uninsured children come from low-income families living below 200 percent of the federal poverty line (FPL) and 42 percent come from families living below 100 percent FPL. The report finds that over the past few years an increasing number of lower-wage workers have been dropped from employer-sponsored health coverage or have seen their share of coverage premiums increase; only 17.4 percent of families in the bottom fifth of the income scale (approximately equivalent to 100 percent of the FPL) received employer-based family health care in 2007, compared with 68.2 percent of children in the middle fifth of the income scale.
To address these and other concerns, RESULTS supports legislative proposals that:
The Children’s Health Insurance Program (CHIP)
Nearly 28 percent of children in the U.S. receive health coverage through public insurance programs, such as Medicaid and the Children’s Health Insurance Program (CHIP). CHIP was created through the Balanced Budget Act of 1997 to help states provide health insurance coverage to uninsured children. CHIP was designed to cover children (and some parents) whose family incomes were too high to qualify for Medicaid, but for whom private health insurance was either unavailable or unaffordable. Under CHIP, states have the choice of expanding Medicaid, establishing a separate, stand-alone program, or combining these two approaches.
Since CHIP was first enacted, the number of uninsured low-income children in the U.S. has decreased by one-third. In 2008, CHIP covered over 7.3 million children. Together, CHIP and Medicaid cover over one-quarter of all children and half of all low-income children.
CHIP has played an important role in reducing the number of uninsured children in America and provides a crucial safety net for families in a time of slow economic growth and eroding employer-based coverage. Children enrolled in CHIP are titled to regular checkups, immunizations, doctor’s visits, and hospital care.
On February 4, 2009, President Obama signed the Children’s Health Insurance Program Reauthorization Act (CHIPRA), after having passed the House and Senate. The bill that was adopted is similar to the bills vetoed by President Bush in 2007. It extends the program for four and one-half years and covers about 4.1 million additional children. The cost is paid for with an increase in tobacco taxes and with restrictions on payments to doctor-owned specialty hospitals.
One of the most important improvements made in CHIPRA is that it allows states to waive the current five-year waiting period for legal immigrant children and pregnant women, as called for in the Immigrant Children’s Health (2008) Improvement Act (ICHIA). Until 2009, CHIP was generally not available to legal immigrants for the first five years they were in the U.S. (some states used their own state funds to cover qualified legal immigrants). RESULTS strongly supported CHIPRA and applauds Congress for making children’s health care a priority once the 111th Congress was sworn in.
CHIP and Health Reform
In 2009, Congress undertook efforts to reform the U.S. health care system. In late 2009, the House and Senate passed their respective health reform bills, both of which addressed CHIP and children’s health. The House-passed bill increases the eligibility for Medicaid to 150 percent of the federal poverty level (FPL) and would move about 2.3 million children into Medicaid. But, beginning in 2014, the CHIP program would end and families with low-income children not enrolled in Medicaid (above 150 percent FPL) would be required to obtain coverage through a new Health Insurance Exchange. The Senate-passed bill extends the CHIP funding through 2015, and requires states to maintain CHIP income eligibility levels through 2019.
These differences led to some disagreement among children’s advocates. A group led by Children’s Defense Fund, with First Focus and Voices for America’s Children, stressed the need to keep coverage for CHIP children affordable for families; ensuring comprehensive benefits for children in CHIP; reducing administrative barriers that make it difficult for families to enroll their children; and protecting gains made with CHIP in reducing the uninsured rate among children. Other advocates feel that House provisions to phase out CHIP are not that bad, and that many children will be better off in Medicaid or the Exchange, provided that insurers are required to maintain the same range and quality of services as CHIP provides. This particularly makes sense if the whole family is on the same insurance plan. In December 2009, the Center on Budget and Policy Priorities (CBPP) issued a revised paper stating that under the House bill, even though there will be a small percentage of children who will be worse off than under current law, 95 percent of children in the U.S. would see no change or be better off.
RESULTS shares many of the concerns about the status of children in the pending health reform bills. The Senate bill continues CHIP intact, rather than ending it and moving children to an unproven health Exchange. However, the Senate bill still does not ensure all children the comprehensive, affordable and simple coverage they need to survive and thrive. Children’s Defense Fund notes that the CHIP program is projected to cover more than 14 million children by 2013, but when the CHIP money runs out for a state, the Senate bill only offers a tax credit for families to buy coverage through the Exchange. Furthermore, most children in the Exchange are eligible for some basic benefits, but would not have access to the full range of benefits they can get in Medicaid or CHIP. Children should receive a child-specific benefit package at least as good as current CHIP and Medicaid enrollees, whether covered by a government program or by insurance purchased through the Exchange.
Guaranteeing that children’s coverage is comprehensive and child-centered is fundamental to ensuring that the unique developmental and preventative health care needs of children are met. Currently 9 out of 10 children have health coverage, but recent research shows that children receive recommended care less than half the time, primarily due to the high cost of services not covered by private insurance packages. Medicaid’s EPSDT benefit covers all medically necessary care for children, including preventative and primary care, dental, hearing, and vision, as well as all acute and long-term health care services. The EPSDT program further promotes access by limiting cost-sharing and out-of-pocket expenses for children’s coverage. RESULTS will continue to push Congress to expand access to the quality care provided under Medicaid’s EPSDT program to all children who receive coverage through the Exchange.
Regardless how the CHIP provisions come out in the final reform bill, health care reform holds the promise of improved dental care for children. In mid-October, National Public Radio (NPR) noted that each of the key national health proposals calls for expanding coverage of pediatric dental care, long a concern of children’s health advocates. NPR quoted Amir Moursi, chair of the department of pediatric dentistry at New York University’s College of Dentistry, who said, “The silver lining of all this heated debate, for children at least, is that in almost every conversation, in every version of a bill, there’s some provision for children’s oral health.”