It would be one thing to cut child health insurance funding if the money wasn't there. But the Bush administration just allowed $1 billion in federal funds already allocated to pay for health care for uninsured children return to the treasury. And on the campaign trail, the president has been using concern for uninsured families as a talking point when playing up his "health savings accounts"—though they'd be virtually useless for poor families. Rachel Klein of Families USA says the actions and the words just don't match up.
Rachel Klein is deputy director of health policy for Families USA, a national nonprofit, non-partisan organization dedicated to the achievement of high-quality, affordable health care for all Americans.
Uninsured Americans are a popular political football this fall. In the limelight of the Republican National Convention this summer, President Bush made lofty promises about expanding health insurance coverage for uninsured children. But, despite the president’s rhetoric about his concern for uninsured children, he stands in the way of efforts to help them. With much less fanfare than his statements at the Convention, the Bush administration recently withdrew more than $1 billion that were earmarked for children’s health coverage.
There are 8.4 million uninsured children in the United States. However, at midnight on Sept. 30, 2004, approximately $1.1 billion in federal funds previously allocated for the State Children’s Health Insurance Program (SCHIP) were taken from the states and returned to the U.S. Treasury. Those funds approximate the annual cost of providing health coverage for almost 750,000 uninsured children.
The decision to withdraw $1.1 billion in health funds for low-income children could scarcely come at a worse time. For the past several years, states have struggled with unprecedented fiscal problems, and these difficulties have led to significant cutbacks in public health programs. At the end of June 2004, these problems were compounded when the president and Congress allowed a temporary state fiscal relief program to lapse. The end of this temporary program, which provided states with increased federal matching funds for their Medicaid programs, meant that billions of dollars for health coverage were lost. The additional loss of SCHIP funds will make it even more difficult for states to meet the health care needs of children.
Washington Support For Children
SCHIP was enacted in 1997. At that time, 10 million children in the United States were uninsured. Approximately 7 million of those children were in families with incomes below 200 percent of the federal poverty level. Although the vast majority of uninsured children had a parent who worked—75 percent lived with a parent who worked full-time, and almost 90 percent lived with a parent who worked full- or part-time—these families either were not offered health insurance by their employers or could not afford to purchase it.
The enactment of SCHIP gave states $40 billion over 10 years to provide health coverage for low-income, uninsured children who live in families that earn too much to qualify for Medicaid but not enough to afford private insurance. After the passage of SCHIP, most states moved quickly to design and implement expanded health coverage for children. Ultimately, all 50 states, the District of Columbia, and the U.S. territories opted to participate in SCHIP. States undertook outreach efforts to inform low-income families about the program, and most states made it easy for families to enroll their children. As a result, families flocked to the programs, and enrollment grew quickly.
Currently, the program is providing coverage to almost 4 million children. SCHIP, in tandem with Medicaid, has served a vitally important role for children: Because of SCHIP and Medicaid expansions, the number of uninsured children remained essentially unchanged from 2001 to 2003, a remarkable accomplishment in light of an increase in the number of children in poverty and a significant decline in the number of children in families with job-based health insurance.
Why Insuring Children Counts
The health insurance coverage provided through SCHIP is vital to improving children’s access to health care. Recent research has shown that children enrolled in Medicaid or SCHIP are three times more likely to have a usual source of care than are uninsured children. And children enrolled in Medicaid or SCHIP are 1.5 times more likely than uninsured children to receive well-child care, see a doctor during the year and get dental care.
Without enough federal funding for SCHIP, states will be forced to limit or cut back the number of children they enroll. Already in 2003 and 2004, more states moved to reduce SCHIP enrollment by reducing outreach efforts, increasing premiums, and making it more difficult for children to sign up for coverage and to keep that coverage for a whole year. And unless states are assured they will receive sufficient federal funds to maintain and build their programs until 2007 (when the program will need to be reauthorized), more states are likely to follow suit. This would take the country in the wrong direction—causing more children to be uninsured instead of ensuring every child a healthy start in life.
