By Jocelyn Guyer
Dr. Fairbrother and her colleagues at Cincinnati Children’s hospital have just come out with an excellent new study that takes a clear-eyed look at how often children end up losing health coverage after a parent loses a job. The results are powerful, but not pretty — between 2000 and 2004, almost one in three kids lost coverage when their parents lost a job (311 out of every 1,000). And, the rate is much higher for low-income children (456 low-income children out of every 1,000 lost their coverage when a parent lost a job). With the latest government data indicating that in 2009, there were 9.4 million families with at least one unemployed member, these are alarming findings.
As bad as this news seems, one bright spot is that this is a problem we can fix by helping these children secure affordable coverage options through Medicaid and CHIP as their parents get back on their feet. And, I’m willing to bet that we’ve actually already made some significant progress since 2004, the latest year for which data were available for the new study. Thanks to the hard work of Governors, state-based advocates, and political leaders in Washington who have made a strong commitment to covering children, many of the children in families losing jobs now are eligible for Medicaid or CHIP and, increasingly, they are facing easier, more family-friendly enrollment procedures. Especially before their budget situations deteriorated, states across the country were getting rid of red-tape barriers to coverage and extending Medicaid and CHIP eligibility to additional children.
Since the downturn, states have largely held onto the gains in coverage (although concerns are increasing about cuts to provider reimbursement rates) and some are continuing to push forward. This ability to “weather the storm” has been due in large part to a short-term, temporary increase in the help that the federal government provides states in financing Medicaid.
Now, however, we are coming up on a critical moment that brings the importance of Dr. Fairbrother’s research into sharp focus. At the end of this year, the extra help the federal government has given states is slated to expire even though state budgets continue to be battered by rising demand for services. Without a short-term continuation of the extra help, states will be under enormous pressure to scale back Medicaid and CHIP, including children’s coverage. (They can’t do it directly because the new health law requires a maintenance-of-effort when it comes to Medicaid and CHIP eligibility rules and procedures but there are indirect ways to cut back on coverage that states may be forced to consider such as slashing the number of state workers who can process applications or cutting reimbursement rates so deeply that children cannot secure needed care.) If this happens, the reality documented by Dr. Fairbrother that children often lose their private coverage when their parents lose a job will translate into more and more uninsured children. We will have a much harder time “catching” them in Medicaid and CHIP, and offering their families the peace of mind that comes with knowing that at least their children can still get health care. On a more global scale, we could end up with a deeply disturbing result – more children becoming uninsured even as the country moves forward on implementation of broader health reform in 2014.
At Georgetown, we work closely with state officials and advocates who are addressing these issues in the states, and the sense of urgency is palpable. If leaders in Washington don’t come through quickly with an extension of federal fiscal relief, it may threaten a lifeline that can help millions of families stay afloat in the midst of unprecedented job loss.
