This month, CCF is heading to Nashville, Tennessee to listen to the new beat coming out of “Music City, USA.” Tennessee Governor Phil Bredesen recently changed his tune and announced that on March 1, enrollment will resume for CoverKids, the state’s CHIP program. The Governor had frozen enrollment in November but, after a public outcry, he decided to tap a state rainy day fund for public health programs to reopen enrollment in CoverKids.
Nearly all states have held steady in their coverage of children over the past year despite their dire fiscal situations. They were helped by strong public support for covering children in families hit hard by the recession and additional federal support for Medicaid programs included in last year’s economic stimulus package. Tennessee was one of only three states that implemented an enrollment cap, and it now joins California in reversing the decision. California halted enrollment in its Healthy Families program in July 2009 and did an abrupt about-face in September after policymakers came up with additional funding to reverse the unpopular decision. Hopefully Governor Bredesen’s decision will be a signal to other states contemplating ways to fill budget gaps, and to Arizona which was the third and now the only state with a freeze on enrollment, that cutting children’s health coverage during an economic downturn is not in tune with what America values.
The news is music to the ears of the parents of the 145,000 uninsured children in Tennessee who may be eligible for coverage. CCF’s Cathy Hope spoke to Michele Johnson at the Tennessee Justice Center, one of the groups that successfully encouraged the Governor to reconsider his decision to freeze enrollment.
CCF: Hi, Michele. Thanks to all of your hard work, this is a great day for Tennessee families. Can you tell us about what happened in your state?
Michele: We are so thankful to Governor Bredesen for reopening this program. It is a great first step for Tennessee children and families. It sends a message to the hard-working, middle-class families who rely on this program that they matter, and when they are facing this tough economy, the state will not abandon them entirely when they are most in need of help.
CCF: So what changed? In November, the Governor said the state didn’t have the money to keep the doors to CoverKids open.
Michele: Nothing has changed in the budget, but I think our Governor had a change of heart. Perhaps he heard a few of the stories we hear everyday of hard working families, playing by the rules, who are forced to watch their children needlessly suffer because they have no insurance and cannot afford the medical care that will end their suffering. Perhaps he heard from families who as a consequence of CoverKids being closed went bankrupt to get the care their children needed. The leading cause of bankruptcy in Tennessee is medical debt. Perhaps he heard from a mother who, like so many in Tennessee, lost her job due to the economy and lies awake at night worried about what she can sell to get her child’s asthma medication. Unemployment is at 10.9% in Tennessee so there are a lot of people in that boat. I do not know, but I do know lots of people have prayed for this change of heart and I am grateful for it.
CCF: What will this mean for Tennessee children?
Michele: Health coverage is essential to children’s ability to grow and learn. An investment in a child’s health helps launch them on a strong trajectory to adulthood. Research shows children with health insurance are more likely to get the health care they need, have better overall health, miss school less, and are less likely to end up in the juvenile justice system. It just makes sense, children who are sick cannot learn.
We still have a long way to go in terms of children’s coverage in order to catch up to the rest of the country. We need to cut the red tape that families face when they try to enroll. We can do that by simplifying enrollment and improving retention policies. It’s bad enough that neighboring Alabama beat us at football and then went on to win the National Championship, but it is unacceptable that they got $39 million in performance bonuses and Tennessee hasn’t done enough to even qualify for them. Tennessee has only done 2 of the 8 CHIPRA simplification procedures.
We also have a long way to go in getting kids the care they need. On one of the key indicators about the effectiveness of a health care system- infant mortality- we are at the bottom of the nation. We are number 47.
Memphis, the largest city in the state has the worst infant mortality rates of any city in the US. For 1,000 live birth 16 babies in Memphis die. Thinking globally, that puts Memphis babies behind developing nations like Malaysia, Aruba and way behind the children of Botswana.
CCF: How many children will this help?
Michele: There are 145,000 uninsured children in the state. About 56% of children in Tennessee are below 250% of poverty. But CoverKids allows higher income children to buy into the program, as long as they are not eligible for Medicaid and do not have access to insurance through a parent’s employer. I would assume most of these uninsured children would qualify for this program.
CCF: You said this is a good first step, what are the next steps?
Michele: The next step is getting the eligible children enrolled. There is a lot of red tape that could be cut to make this a success for these families. We need only to look to our neighbor to the South to see how it’s done. Alabama not only won the national college football championship, it beat Tennessee and all other states on improving children’s health coverage and won the largest performance bonus from HHS.
Just as the Tennessee Volunteers are heading into spring training to prepare for next season, we need to roll up our sleeves and get to work to make sure Tennessee children have the health coverage they need to be competitive in school and successful in life.
CCF: What specific policy changes would you recommend?
Michele: We need to adopt for Medicaid and CHIP procedures that get eligible children on these programs (and keeps them on) such as:
- 12-month continuous eligibility
- Use of a joint application for Medicaid and CHIP, including the supplemental forms and “information verification process”
- Automatic renewal where the state provides a pre-printed form and eligibility will be renewed unless the state gets other information
- Presumptive eligibility for children
- Express Lane Eligibility
CCF: What lessons do you see in the Tennessee experience?
Michele: That it is a huge mistake for a Governor to freeze enrollment and deny affordable health coverage to children. This economy is hurting Tennessee families everyday. They need to know that their state will be there for them and their children. And they need to know that when it’s raining hard in their communities, state rainy day funds won’t be hoarded — they will be used to help families and bring more funding to the state by drawing down federal match. Denying children health insurance and saying it will save money is similar to telling the Department of Transportation to stop changing the oil in their cars because it is unaffordable. Eventually we will all pay.
The public strongly supports children’s health coverage initiatives and they should remain a top priority in state budgets no matter how badly the recession impacts state resources. I would encourage other state advocates to keep speaking out for uninsured children and to remind policymakers that the public stands behind children’s health coverage initiatives.
CCF: What challenges do you see ahead for Tennessee and other states?
Michele: As employer coverage declines and more and more families lose access to health coverage, states will have to step up to the plate to help families. What we really need is broader health reform to be passed on the national level so we can better manage escalating health care costs and provide families and individuals with access to secure, affordable health coverage that won’t disappear if they lose their jobs.
CCF: Thanks for taking the time to share this wonderful news with us.
