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Health Insurance for Children - We Can Do Better

(Ron Carlson) -- Ten years ago Congress authorized the State Children’s Health Insurance Program (SCHIP).  In a few months, unless there is a reauthorization, the program will end.  I don’t think that will happen, but there’s a good chance it will be under funded.   Whatever the outcome, the current SCHIP debate reminds us how far we have to go in getting SCHIP coverage to all eligible children.  

At the time of the original policy debates over SCHIP in 1997, many of us who were involved in the discussion, including me, worked to make our nation’s health care system a bit more equitable, accessible and sensible.  We saw SCHIP as the step that would help give universal health care to all children.  As a country we believed we were finally going to be taking care of the kids who had long fallen “between the cracks”, i.e., those not poor enough to qualify for Medicaid but whose families couldn’t afford to buy insurance.  

During this “interlude” when Congress is “deliberating” over SCHIP’s future, I think we should explore some new and/or “renewed” thinking about how we in Howard County (or elsewhere for that matter) can do a better job in finding and enrolling SCHIP eligible children. Even after ten years of working to get coverage to all kids, I was surprised to learn how many still don’t have the insurance protection for which they are eligible.  According to the Maryland Department of Health and Mental Hygiene (DHMH), which administers SCHIP here in Maryland, about 110,000 eligible kids have not signed up for either SCHIP or Medicaid.  About half this number is in families with income less than 300% of poverty, the eligibility limit for SCHIP.  Even here In Howard County, a “back of the envelope” estimate says as many as 2,000 kids aren’t signed up but should be. County agencies, especially our own Health Department, Social Services and Howard County Public Schools have been diligent in trying to find the kids and getting them signed-up. Non-profit agencies and the faith community have been involved as well.  Nevertheless a large number still needs to be identified and enrolled.     

After SCHIP began, the percentage of children nationwide without health insurance fell by about 1/3 between 1997 and 2004.  Then came setbacks.  The Kaiser Commission on Medicaid and the Uninsured released data earlier this year indicating that  in recent years, a large number of employers have been reducing or dropping employee family health coverage.  As employer sponsored coverage declined, the number of uninsured children rose for the first time since 1998, canceling out the coverage gains that had been made over the prior period.    

What all of this tells me is we need to get back to work.  We need to identify who and where the families are with uninsured children. We must reach them with user friendly information and make sure they enroll.  That said, the job is not an easy one.  There are some hurdles.

In May of this year, the Kaiser Commission issued another report, this one pinpointing to reasons why kids are not enrolled.  A long standing problem is that many poor families believe that Medicaid, and especially SCHIP, doesn’t apply to “working families”.  Some conclude that because they are working, they aren’t eligible. Others simply stay away because they don’t want to admit they need help. Many just don’t know about the program or where to get help.

Around the country, communities are moving forward again signing up kids for SCHIP. Local leaders are pushing the issue to the community’s front page. One mid-western governor recently championed an “All Kids” program and got personally involved in promoting SCHIP.  Businesses and government agencies are coming up with new “out-of-the box” outreach initiatives. The effect is contagious once a program is launched. 

We need our own “rejuvenated” enrollment campaign in Howard County. We need even stronger partnerships between local government, the non-profit and business communities to conduct better outreach and education efforts.  At the same time we must recognize that Howard County has changed in ten years. It has become more diverse. Many children and families are harder to reach due to barriers presented by language and culture. We can however, use many tools and “best practice” examples from counties in addition to coming up with innovations of our own.

Now is the time to be proactive as the Congress and others continue their deliberations over the SCHIP’s future. Assuring that children have access to health care is as important as anything else we can do to improve their health and well-being. We have long held that all our children must have access to public education and be enrolled in a school system. Seeing that our children get the health care they need should be treated with the same level of importance.