October 25, 2012
Dan Munro
I’m sure there are a few lists that State Governors are anxious to boast about when they get together for their National Governors Association Annual Meeting in the summer. This isn’t one of those lists.
States With Highest Rate of Uninsured Children
- Nevada – 16.2%
- Texas – 13.2%
- Arizona – 12.9%
- Florida – 11.9%
- Alaska – 11.8%
Yesterday, the Georgetown University Health Policy Institute – Center for Children and Families released an 11 page report called Uninsured Children 2009-2011: Charting the Nation’s Progress (pdf). Among the key findings:
- In 2011 there were 5,527,657 Uninsured Children Nationally.
- Half of the nation’s uninsured children live in just six states: Texas, California, Florida, Georgia, Arizona, and New York.
- Twenty states showed significant declines in uninsurance rates for children.
- Nevada has the highest rate of uninsured children (16.2 percent).
- Nationwide, Hispanic and school-aged children were disproportionately uninsured as well as those living in rural areas.
Overall, the news was actually positive in one respect. The Children’s Uninsurance rate has declined nationally (by about 1%). That was the good news. The more sobering news was that while uninsured rates declined, children’s poverty rate increased.
Another finding was that approximately two-thirds of uninsured children that are eligible for Medicaid and CHIP – aren’t enrolled. For states like Arizona (where we live) there’s a relatively easy explanation for that. The Governor – in this case Jan Brewer – simply froze enrollment. At a time when the economic impact of our Great Recession was hitting the hardest, the Governor simply turned off access to basic healthcare resources for thousands of kids. The Kaiser Family Foundation wrote a Policy Brief (pdf) on that freeze last year. From that brief:
Arizona is currently the only state in the country with an enrollment freeze in its Children’s Health Insurance Program (CHIP – called KidsCare in Arizona). The freeze in Arizona’s KidsCare program has had a significant impact on enrollment. Since January 2010, the number of children covered through the program has declined by more than 60 percent and over 100,000 children are on the waiting list. Though a sizable share of disenrollees transitioned to Medicaid as a result of declining family income, based on the experience in other states, it is likely that many of the disenrolled children and children on the waiting list have not been able to secure another source of coverage and are uninsured. Some of these uninsured children may continue to receive some care, either through a community health center or other provider, but it can be expected that a number of them are going without needed services. Moreover, when these children receive urgent or emergency services, their families often face a significant financial hardship to pay for these services.
In a desperate attempt to provide some relief – the State initiated a temporary fix in the form of a new program – KidsCare II. Open enrollment began in May of this year and full capacity was reached in less than 4 months. Coverage under KidsCare II is set to expire on January 1, 2014. The effects of an entire state that has frozen enrollment in their CHIP program is significant, and like so much of healthcare – ”cost-shifted” in countless other ways downstream to clinics, shelters and hospital emergency rooms.
Today, when we hear the phrase Mobile Health – or mHealth – we mostly think of apps, smartphones and tablets or wearable tracking devices and monitors. All of that is true, of course, but mHealth has at least some of its roots in the Children’s Health Fund (CHF) charity. CHF was founded in 1987 by singer/songwriter Paul Simon and pediatrician/advocate Irwin Redlener, M.D. The organization started with a single mobile medical unit which was designed by Dr. Redlener’s wife. Today, the organization has 23 separate programs and more than 50 mobile medical units in major metropolitan cities like Austin, Dallas, Detroit, Chicago, Los Angeles and San Francisco. Here in Phoenix the Crews’ n Healthmobile is an innovative partnership between Phoenix Children’s Hospital and CHF that was formed in 2000. Randy Christensen – or Dr. ‘C’ as the kids call him – has been at the helm of the outreach program since its inception.
Dr. ‘C’ (left), Erika Borunda – Reece Tovar (2nd from right) and Staff
I asked Dr. Christensen what impact he’s seen with the end of enrollment in KidsCare. On the back of a piece of a paper he quickly scrawled this chart:
The numbers are estimates, of course, and you’re welcome to challenge them – but I wouldn’t. Inside the big blue RV is a wireless network and Toshiba Laptops that are all running EHR software from eClinicalWorks. Dr. Christensen has records on the kids he sees going back most of the 12 years. That dataset has a wealth of information about kid’s healthcare just waiting to be tapped.
At some point we’ll find the funds to analyze this data and I think we’ll be really surprised with the size and scope of the information on this unique population. It could also help other cities and countries as they work to treat kids with emergency, rescue, behavioral and just plain healthcare issues. I see many of these kids over a period of time – often years. Many have not only survived – but they are doing some pretty amazing and productive things with their life. We don’t get much of a real shot at any preventative care – but seeing the influence we do have is really rewarding. This is really what practicing medicine is all about.
The passionate commitment of doctors like Randy Christensen is real and palpable. The kids sense it because it’s not something you can fake. There is, however, a real frustration that’s also palpable because it’s such an integral part of rescue care delivery. It comes from seeing kids every day that don’t have access to ongoing primary and preventative care. You can bandage them up. You can prescribe antibiotics for an abscessed tooth – because you don’t have access to dental care. You can find a way to get drugs to a kid with walking pneumonia who was given a prescription months earlier that he can’t afford. All of this will make a difference in the lives of these kids and they often survive and thrive. But many don’t – or the lack of care winds up handicapping and debilitating in other ways too. In the end you can’t substitute what you know is right – with what’s expedient and affordable. Kids need healthcare insurance and healthcare too. Just like the emergency room care we wrote about earlier this week – rescue care isn’t healthcare. For about 5.5M kids– rescue care is their only shot.
