Public: Government should provide more kids' coverage

Washington -- Congressional inaction, state government cutbacks and steep declines in private coverage have conspired to keep nearly 8 million children uninsured, according to experts' analyses of recent trends.

Eighty-four percent of Americans say it is the responsibility of federal and state governments to ensure adequate funding for the health care needs of all children, according to an online report published in September by Health Affairs.

But 59% of respondents also say they think the health care needs of children are not being met. Many people aren't even aware that children are relatively inexpensive to provide coverage for compared with seniors, the report showed.

"The fact is that most uninsured children are eligible for free and low-cost coverage under programs such as Medicaid and the State Children's Health Insurance Program," AMA President John C. Nelson, MD, MPH, said in a statement about the Association's support for the Covering Kids & Families campaign. "Unfortunately, many parents do not have the right information to complete the enrollment process, and some assume that their children will not qualify for the programs."

Due to the constant turnover in the SCHIP population, local outreach efforts are essential to maintaining the program's enrollment levels, said Vernon K. Smith, PhD, principal with Health Management Associates, a national health care research and consulting company. Those efforts also have unfortunately been one of the first casualties of state budget cuts.

Aggressive outreach in the first few years of SCHIP helped drive large jumps in public coverage for children, helping to balance out significant drops in private coverage seen since the 1970s, said John E. Lewy, MD, chair of pediatrics at Tulane Hospital for Children, New Orleans, and chair of the American Academy of Pediatrics' committee on federal government affairs.

Another Health Affairs article, published in the September/October issue, shows that coverage of children through private health insurers dropped considerably starting in 1977.

Since that time, the rate of private coverage for low-income children has dropped from 55.4% to 38.2% in 2001, due to increased poverty and rising premiums, the study's authors found.

Recent data suggest that as private coverage continues to wane, public programs no longer may be able to take up the slack -- a troubling trend seen over the past few years in the growing number of uninsured adults.

"We really fear what the 2004 data are going to look like," Dr. Lewy said.

Despite the recent problems, support for SCHIP remains strong among the public and politicians. But Congress has yet to act on several measures that could help shore it up.

Children's advocates have been urging passage of legislation that would give states access to about $1 billion in expired SCHIP funds. But with time running out this session, lawmakers seem to lack the political will to pass it unless they can find a way to offset the funds, Dr. Lewy said.

"The thought of letting funds expire and losing funds that are used to enroll more kids and provide services ... would be a terrible thing," he said.

Congress also has failed to take up MediKids legislation that would create an option that would automatically cover any child eligible for public or private insurance but not yet enrolled in those plans.