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Health Affairs, 23, no. 5 (2004):
26
doi: 10.1377/hlthaff.23.5.26 © 2004 by Project HOPE |
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Children's Coverage |
PROLOGUE
Children’s Insurance Coverage: Advances And Retreats
PROLOGUE: It is a maxim of health care policy that the best medical care in the world is meaningless to those who do not have health insurance coverage or cannot afford it. The continuing increases in health care costs combined with a sluggish economy have meant that the number of uninsured people continues to grow in the United States. Yet one of the bright spots is coverage for children. After President Bill Clinton’s failure to enact universal coverage in 1994, incrementalists began focusing their attention on gaps in children’s coverage. If the United States could not afford to cover all of the uninsured, the advocates argued, it could at least try to extend insurance to the most vulnerable members of society: children. That campaign bore fruit in 1997 with the enactment of the State Children’s Health Insurance Program (SCHIP), which built upon the Medicaid expansions of the 1980s to include more near-poor families in states’ eligibility criteria.
By nearly every account, SCHIP has been a success, and the following four papers document its progress. The first paper presents the long view from Peter Cunningham, senior researcher with the Center for Studying Health System Change, and James Kirby, a service fellow with the Agency for Healthcare Research and Quality (AHRQ), who conclude that children’s health care coverage has improved to levels not seen since the late 1970s. The reversal of some key demographic trends such as the decline in family income and two-parent households has reduced children’s poverty, while expansions in public coverage have closed the gaps in the safety net, leading to better coverage for children. The authors conclude that the most important factor in health care coverage for children today may be the affordability of health insurance premiums.
Thomas Selden, Julie Hudson, and Jessica Banthin of AHRQ follow up with a closer view of children’s coverage and eligibility for SCHIP. Between 1996 and 2002, they write, the proportion of children eligible for free or heavily subsidized coverage went from just over one-quarter to nearly one-half of all children, which drove a strong increase in the number and percentage of formerly uninsured children now covered by public programs. Next, Genevieve Kenney of the Urban Institute and Debbie Chang of the Nemours Foundation praise SCHIP yet caution that equity, financing, and enrollment issues remain. Finally, Andrew Dick of the University of Rochester medical school and his colleagues show that SCHIP has improved access and satisfaction among low-income and vulnerable children in three states reviewed. They show, however, that special-needs children still have unmet needs and that children, especially Hispanics, may still not be receiving the preventive care they need.
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