The challenge of children’s coverage…

Last week, Families USA released a report, Left Behind: America’s Uninsured Children, which detailed that there are 8.6 million uninsured children in the United States, using 2005-7 averaged numbers from the U.S. Census Bureau.

Over 1.25 million of those uninsured children are in California. There are other estimates, using different definitions, that are a bit lower, but the scale is similar: there are simply too many kids, overwhelmingly with working parents, who are not covered. Not surprisingly, they typically have worse health status. And their parents are one emergency away from financial ruin.

The saddest part is that until recently, California was making real progress on the goal to universal children’s coverage.

While employer-based coverage was being scaled back, especially for dependents (such as spouses and children), public insurance programs like Medi-Cal (Medicaid) and Healthy Families (SCHIP) were more than picking up the slack. In the recent economic downturn, we’ve seen even further increases in enrollment in Medi-Cal, which covers over 6.6 million Californians–about half of them children, and in Healthy Families, which just hit the 900,000 enrollment level. Several counties offer a “Healthy Kids” coverage program with more expansive eligibility rules, to get all kids covered.

But in the last year, California’s effort to cover all children has slipped.
* President Bush vetoed efforts for a full reauthorization of the State Child Health Insurance Program (SCHIP), throwing California’s version of the program, Healthy Families, into some uncertainty. The federal program needs to be reauthorized by March 2009.
* California’s budget crisis has taken its toll: Unless the Legislature intervenes, the board that runs Healthy Families is considering stopping enrollment and creating a waiting list for Healthy Families that would deny coverage to over 160,000 children.
* Yet the Legislature, in an effort a few months ago to make cuts (the alternative of revenues having been blocked by by Republican legislators), has already passed additional burdensome reporting requirements that will have the effect of dropping over 250,000 children off of Medi-Cal coverage. And Governor Schwarzenegger, using his line-item veto, also made it harder for children to get enrolled into coverage in the first place.
* Also, many of the local “Healthy Kids” programs are running out of money as well, and thousands more children may be disenrolled without state assistance.
* Finally, this is in a context of an economic downturn that may mean more children losing private coverage that their families get through an employer or buy directly, and so these cuts come at a time when these public programs are actually in greater demand.

This issue isn’t a tough policy puzzle: we know exactly what we need to do to cover virtually all children; the question is raising the money needed, as part of deciding our priorities and choices as a state. The issue has never lacked for individual champions, whether outgoing Assembly Budget Chair John Laird, or incoming Senate President Pro Tem Darrell Steinberg, or many other legislators past and present.

What we need in these tough times is collective leadership, from the Governor and legislative leaders of both parties, that children’s health coverage is a priority that needs to be preserved despite–actually, especially because of– these tough economic times.

The new legislative session starts tomorrow. Children’s coverage is not the only, or even the biggest, health care issue on the agenda, but given the challenges outlined above, it is the most urgent.

Health Access California promotes quality, affordable health care for all Californians.

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