November 06,
By Brendan Kirby,
Alabama has done a better job than all of its Southern neighbors and ranks among the top fifth in the country in providing health insurance to children, according a new study by Georgetown University’s Health Policy Institute.
The report found that the steady decline in the children’s uninsured rate across the country since Congress created the Children’s Health Insurance Program in 1997 has slowed. In some states, it has even reversed.
But Alabama stands out among Southern states. The 48,181 residents younger than 18 who had no health insurance in 2013 represented just 4.3 percent of all children. That is the 10th-lowest rate in the country, well below the national average. Alabama moved up eight places from 2011, when it ranked 18th.
The rate was a full percentage point lower than in 2011, tied with Arizona for the 10th-highest reduction.
“We have a legacy there. It’s a real point of pride,” said Jim Carnes, a senior policy analyst for the anti-poverty group Arise Citizens’ Policy Project. “We have a long history of keeping our children’s health coverage strong.”
Carnes said the state laid the groundwork early, before Congress even had adopted the program. When the law did pass, he said, Alabama was ready. He said lawmakers from both parties have protected the program from budget cuts and the state has worked well with community organizations to sign people up.
“This is how government is supposed to work,” he said. “It’s not often that Alabama is the exhibit for that. But here we are.”
Cathy Caldwell, the director of Alabama’s program – known as ALL Kids – attributed the state’s ranking to a simplified application process and close cooperation with community groups in getting the word out.
“We work very, very closely with the Alabama Medicaid Agency. We’ve always shared a joint application,” she said. “That’s been key since day one to help simplify that navigation for families.”
Alabama uses a relatively generous income eligibility threshold. When the program took effect, children up to twice the federal poverty line who did not qualify for Medicaid could get insurance from ALL Kids. Effective Oct. 1, 2009, the state Legislature raised that cutoff to 317 percent the poverty line. For a family of four this year, that works out to a little more than $75,000.
The minimum required by the federal government is 132 percent of the poverty line. The average state caps eligibility at 255 percent of the poverty line, said Joan Alker, executive director of Georgetown’s Center for Children and Families.
Because of its high rate of poverty, Alabama gets a relatively high federal match. The federal government pays 78 cents out of every dollar spent on health coverage. Caldwell said state’s share for this fiscal year is about $40 million.
Studies examining the effects of the CHIP program have been mixed, with some indicating improved health and others showing no impact, according to a review by the Kaiser Family Foundation.
Alker credited Alabama with having a “very efficient Medicaid and CHIP program for kids” and praised Caldwell as a strong CHIP director. She said most of nation’s uninsured children, 68 percent, are eligible for health insurance under CHIP but not signed up. She said Alabama does a better job than most states informing families that the program exists.
“It’s all about putting out a welcome mat for kids,” she said.
Alker pointed to Illinois, which saw an uptick between 2011 and 2013 in its rate of uninsured children. She attributed that to state budget cuts that reduced outreach efforts. Caldwell said ALL Kids, too, has had to do without outreach fund because of budget cuts the past three years.
But, she added, “Our community partners have stepped up.”
Alker said many children covered by Alabama’s program would not be eligible for insurance through the federal health insurance exchange because of a “family glitch” that uses employee-only health insurance coverage to assess eligibility for subsidies under the Affordable Care Act. The government does not take into account the higher premiums employees would have to pay if they added their children to their company-provide health plans.
The Georgetown study estimates that without CHIP, 5.2 million to more 7 million children would not have insurance.
Alabama’s embrace of the children’s health program stands in stark contrast to its vociferous opposition to the expansion of the state’s Medicaid program under the Affordable Care Act. Gov. Robert Bentley has refused to accept federal funds to increase eligibility.
Carnes and Alker attributed the difference to the fact that uninsured children make up a more sympathetic population.
“I think kids are a special population,” Carnes said. “There’s been a broader consensus that kids deserve as good a chance as they can get.”
But Carnes said his group is pushing the notion that parents’ health affects children’s health. He said he hopes state leaders change their mind on Medicaid expansion.
Alker said expanding coverage to poor adults could lead them to get their children enrolled, as well. She said that was the experience in Massachusetts after it passed a health care reform similar to the Affordable Care Act. It now leads the nation with a children’s uninsured rate of 1.5 percent.
“That’s where a state like Alabama could go even further,” she said.
Alker agreed that children’s health programs enjoy broader support. She noted that the $5 billion CHIP program comes up for renewal next year and said Alabama would lose $185 million if lawmakers failed to do so.
“There historically has been a great deal of bipartisan support for covering kids. … Let’s hope that that bipartisan support continues,” she said.
