Homestretch 1: Children's Coverage -- Do No Harm!
[This is the first in a series of six articles summarizing the leading categories of issues at stake in the final stages -- the homestretch -- of the debate on national health insurance and health care reform.]
In a large sense, comprehensive health care reform is a major winner for all children, apart from the provisions that specifically apply to children. Kids, after all, live in families, and those families live in communities. If parents are insured and healthy, it helps kids: statistically, if parents are insured then children are enrolled, and if parents go to the doctor, then children go to the doctor. It also helps children if there is less financial stress in families, a prime factor associated with family violence and disintegration. And it helps children if they live in communities where people have access to health care and treatment. It helps children if the overall health system costs less and concentrates more resources on the quality of care according to the most effective treatment methods. It helps children if they can get insurance as dependents of their parents, regardless of where they live -- currently, many children are in a senseless lottery where their health insurance status depends on how states or employers treat their parents. And it helps kids to make them insured on their 19th birthday, as if they continue to be important at that age. Health reform is what awaits them on that birthday.
But having said that, as we fight for quality affordable health insurance for every American, it is essential to ensure that the gains made to insure millions of children -- including those made earlier this year by this Administration and this Congress -- are not thoughtlessly reversed. The recently released census data show that the rate of uninsured children is at an all time low, due largely to successful state health insurance programs. But while the figures are encouraging for uninsured children, the numbers are distressing for their parents and other uninsured adults. The President is right in his approach to this complex national problem -- one of the cornerstones to getting it right is to affirm and even expand what works. Above all, that should apply to children. As Congress works through the homestretch, it should include features that guarantee that children's coverage under reform is at least equal to coverage under a good current state SCHIP program, and that we achieve universal coverage for children. The Administration should make it clear that this is its position, too.
All of the proposals currently alive in the House and Senate essentially phase out the State Children's Health Insurance Program (SCHIP). They move kids whose parents' income is below 133% of the federal poverty level (FPL) into Medicaid, and those whose parents' income is between 133% and 250% of the FPL into the health insurance Exchange -- which means those families will be purchasing insurance from an array of private insurance choices (and under all versions other than Baucus', the Exchange will also include the option to purchase a public health insurance plan). The insurance available to cover children under the Exchange could be more costly to many families in the 133% to 250% FPL income range than their current coverage under Medicaid or SCHIP. This cost increase could affect premiums as well as out of pocket co-pays. In addition, the scope and quality of the coverage for children could be diluted under Exchange plans as compared to Medicaid or SCHIP. There are a number of other possible losses for certain children in the Exchange as compared to the current situation in many states.
Several amendments have been added to the House bill that would protect children moving from Medicaid or SCHIP into the Exchange and strengthen SCHIP for those children who remain in the state programs. An amendment introduced by Representative Diana DeGette (D, CO), would require the Secretary of Health and Human Services to submit a report comparing the coverage a child receives under an average state child health plan to that they would receive under the Exchange. No child would be permitted to move from a state program into the Exchange until the Secretary has certified that children will receive comparable care under the Exchange to that they were receiving in the state programs. If the Secretary finds that coverage is worse under the Exchange than under the state programs, changes would need to be made before children could move into the Exchange.
Also, the Scott Amendment, named for Rep. Robert C. Scott (D, VA), would require plans in the Exchange to include the full range of early and periodic screening, diagnosis and treatment services provided for under Medicaid through the age of 21. And three amendments by Rep. Bobby Rush (D, IL) would have ensured that children receive identical coverage through the Exchange that they receive under Medicaid, that cost-sharing and affordability measures under Medicaid would follow children into the Exchange and reduce barriers to enrollment for eligible children.
In the Senate Finance Committee, amendments to the Baucus mark have been filed that mirror those in the House bill regarding protections for children. In addition, an amendment from Sen. Rockefeller (D, W.Va) would continue the SCHIP program until at least 2019.
Those are the battle lines in the coming weeks. Children will benefit greatly from health reform in general. On the specifics, let's make sure that we do not roll back the recent progress on coverage and cost and that we guarantee affordable universal coverage and access to care for children.
