Wendy Lazarus, Founder and Co-President, The Children’s Partnership
As the health reform debate in Congress moves further forward than it ever has before, the potential real-world impacts on children and families are becoming clearer. Even from 3,000 miles away, those of us in California – home of the nation’s largest and hugely successful CHIP program – can see the promise and the perils ahead. Although today I live and work in California, where one in every eight children in the US also lives, my perspective is shaped by having worked as a child advocate in four other states and in Washington DC, starting in 1973. Based on these many years of being in the reform trenches, I can honestly say today feels quite different—something very real is emerging with the potential, still, to be a major gain for America’s children or a monumental step backwards.
The promise lies in the enormous success that our nation generally, and California specifically, has made in covering children. Like many other states, California has made great strides in covering children this decade. Our uninsured rate has fallen from 10.2% in 2001 to 6.4% in 2007, thanks to Medi-Cal (our Medicaid program), and Healthy Families (our CHIP program), functioning as the effective safety nets they were intended to be. California children in families at or below 250% of poverty currently have access to coverage their parents can afford, that provides comprehensive benefits, and that protects families from high out-of-pocket expenses. California has also implemented a number of pioneering reforms to help families find and keep coverage for their children, such as providing expedited “express lane enrollment” for children who receive free or reduced-price school lunch. Evaluation after evaluation has shown that more children in California are now healthier, are at less risk of suffering from preventable illnesses, have better access to needed health care services, and are better prepared to learn.
But as the health reform debate winds to its end, we cannot count on these good things to continue for kids. Unless the final bill includes the right choices on some still unresolved matters, devastating impacts on children’s health and readiness to learn could result. We have the knowledge and we still have the time to make sure the final package does, indeed, build effectively on the strong foundation that already exists.
To a great extent, the current House and Senate bills do build on that strong foundation. Today’s coverage standards would clearly be maintained or even improved for many children. Because both bills expand and strengthen Medicaid, more children – more than 300,000 children in California alone, under the House bill – would gain access to the affordability and comprehensive benefits it provides, including important preventive benefits through the Early and Periodic Screening, Diagnosis, and Treatment program.
But for millions of California children above the new Medicaid income thresholds, the results are not necessarily positive. Both the House and Senate bills create new coverage pathways, through some combination of parents’ employer-based coverage, CHIP, and/or the new health insurance exchange. The specifics differ under each bill and are very complex, but the essential element to watch for is this: Do the reforms result in children in having access to at least the level of affordability and benefits that they have today? The answer could be “yes” for any of the potential pathways if they were structured appropriately. At the moment, however, neither bill has strong enough affordability and minimum benefit requirements for either employer-based coverage or coverage provided through the exchange to guarantee that current standards for children’s coverage will be maintained.
Until the standards for employer-based and exchange coverage are strengthened, CHIP is left as the only coverage pathway for maintaining the successes that we, as a nation, have achieved for children. Both the House and Senate bills maintain CHIP for some period of time for at least some children but important limitations exist in both bills that would leave children in California particularly at risk. Because the House bill only maintains CHIP in those states that implemented their programs as Medicaid expansions, California – with its stand-alone Healthy Families program – would, fairly soon after reform is implemented, need to move 1.7 million children from CHIP to Exchange and employer coverage. Under the Senate bill, California’s CHIP program would be maintained through a transition phase – but without any funding after 2013. Fully funding and guaranteeing CHIP coverage until at least the same benefit and cost-sharing protections are available in the Exchange would protect the gains made to date.
California’s brinksmanship this year provides a sobering example of the perils to families if these funding concerns are not addressed. Earlier this year, California enacted deep funding cuts for Healthy Families that resulted in the program being closed to new enrollees temporarily, leaving nearly 90,000 children on a waiting list for coverage in just 60 days and putting the coverage of nearly one million children at risk. Fortunately, state leaders came together to find alternate funding sources to fill the shortfall and reopen the program. But these “fixes” were temporary, and with the state’s continued fiscal crisis we are likely to see more cuts ahead.
The lesson for health reform is clear: For the health bill that passes to be true reform, whatever pathways cover our children need to be modern, simple, sized right for children and available even in times of economic stress.
My garage is brimming over with files labeled “national health reform” that span three decades. But it is the health reform documents being produced over the weeks ahead that will govern the fate of children born today and in the years to come. We have decades of experience that tell us the right thing to do. And we still have the time and the necessary leadership to do it.
The views expressed by Guest Bloggers do not necessarily reflect the views of the Center for Children and Families.
