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Kids Could Start a Ceasefire in Health Care Wars

By David Sandman, President and CEO, New York State Health Foundation
Published in the HuffPost on August 14, 2017

Following last month’s contentious congressional debate over repealing the Affordable Care Act, the next major battle in the health care wars may already be at our doorsteps. But does it have to be another partisan conflict? What if Congress and the nation could instead declare a ceasefire, return to normal order, and engage in a bipartisan effort to continue and extend health insurance coverage for low-income children?

This next health care fork in the road is the pending reauthorization of the State Children’s Health Insurance program (SCHIP), which celebrated its 20th birthday earlier this month. Throughout its life, SCHIP has enjoyed extraordinary bipartisan support, with Senators Ted Kennedy and Orrin Hatch leading the charge for its initial passage. Created by the Balanced Budget Act of 1997, the program is a joint state-federal partnership that provides low-cost or even free health insurance to low-income children. It has been reauthorized three times since its inception, but funding is now set to expire on September 30, 2017—just about six weeks from now.

Today, 8.9 million children in the United States—including nearly 700,000 kids in New York State—have health insurance through SCHIP. Since the program was enacted, the number of uninsured children nationally has gone down by a whopping 68%.

The program’s success is undeniable. Millions of kids have better access to health care, and they’re getting more of the primary care and preventive services that kids need: well-child visits, immunizations, eye exams, dental check-ups, and medicine. Children who were uninsured and now enrolled in SCHIP are more likely to have a usual source of care and actually visit a health care provider. Kids—particularly those who have a chronic health condition like asthma or diabetes—who have SCHIP coverage are more likely than those who are uninsured to have their health needs met. And racial and ethnic disparities in access to and use of health care largely disappear when kids have health care coverage.

Relatively speaking, the program is inexpensive. Because kids are generally healthy, it doesn’t cost much to provide coverage for them. The federal government spends about $15 billion annually on SCHIP—pocket change compared with the $588 billion it spends on Medicare.

If the nation needs an example of a stellar program, look no further than New York State. Its program—called Child Health Plus— predates the federal one; it was created in 1990 and served as a model for the initial SCHIP legislation. Today, New York State has by far the most generous SCHIP program of any state. Children in families earning up to 405% of the federal poverty level are eligible to enroll, compared with a median income limit of 255% across all states. Child Health Plus reaches and help some middle class families, while most of the children are in poor families; 75% of the enrolled kids come from families earning less than 250% of the federal poverty level. New York also covers (using state funds only) income-eligible children regardless of their immigration status, and covers lawfully-residing immigrants without the five-year waiting period that some states impose. And the program is affordable: families earning up to 1.6 times the federal poverty level pay nothing for their children’s coverage. Those with higher incomes may pay between $9 and $60 per month per child for coverage.

For children, we’ve essentially achieved universal coverage. Largely because of the generosity of the Child Health Plus and Medicaid programs, nearly 98% of New York’s children have health insurance. Nationally, about 95% of kids are covered.

If federal policymakers don’t reauthorize SCHIP soon, millions of children will be at risk. It’s expected that New York State—and more than half of all states—will spend existing SCHIP funds by March 2018. So Congress needs to act quickly to preserve the program and ensure that those enrolled in SCHIP don’t lose their coverage.

It should be a no-brainer to continue a program that is so successful, that provides health care coverage and peace of mind to millions of Americans at a relatively low cost, and that has for two decades enjoyed bipartisan support. Yet we are left holding our breath wondering whether it will be renewed, whether states will have to scramble to find funding in their own tight budgets to continue the program, whether millions of kids will have their insurance taken away.

Our leaders must choose: one path leads to continued gridlock and a loss of health and economic security for Americans. The other path leads us back toward a functional government as well as health care coverage, access, and financial protection. The right choice should be an obvious one, if not an easy one in this polarized environment. For the sake of millions of children across the country, our nation’s policymakers must choose wisely.

Follow David Sandman on Twitter: www.twitter.com/davidsandman1