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March 6, 2007
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Christopher Fleming

SCHIP’s Advances Could Halt If Funding Does Not Increase, Warn Researchers In March-April Issue of Health Affairs

Studies In Thematic Issue On Children’s Health Issues Focus On Disparities, Early Screening Programs, Medicaid, And Reforms To Improve Care

Bethesda, MD -- As Congress and the nation’s governors wrangle with the Bush administration over how much the federal government should spend on the State Children’s Health Insurance Program (SCHIP), an article in the March/April 2007 issue of Health Affairs, released today, examines the first decade of the program and concludes that by many objective standards, SCHIP has been a success, lowering uninsurance rates among children and improving their access to care. The authors warn, however, that if funding is held to its current level, many children could lose their health insurance, and states will be hard-pressed to expand coverage for the nearly two million uninsured children who are now eligible for the program. http://content.healthaffairs.org/cgi/content/abstract/26/2/356

SCHIP covers children whose families earn too much to qualify for Medicaid. The federal government allocated $5 billion to SCHIP in 2007. The program has become an important part of the health insurance safety net, providing coverage to about four million children on any given day. However, fourteen states are expected to run out of money for the program this year, and some states have been exploring the need to cut enrollments soon.

“As SCHIP reaches its ten-year anniversary, the program has become a lifeline for extending health insurance coverage to children and could serve as a platform for addressing broader health care issues for low-income families” said Urban Institute researcher Genevieve Kenney. “Without additional federal funds this year and in subsequent years, low-income children stand to lose coverage.”

In reauthorizing SCHIP, the federal government might consider adjusting the federal funding formula to take into account potential increases in the demand for coverage spurred by economic downturns or the further erosion of employer-sponsored health insurance, write Kenney and fellow Urban Institute researcher Justin Yee in a thematic Health Affairs issue on children’s health. The issue, titled “Designing Children’s Health Care,” is supported by the California Endowment, the David and Lucile Packard Foundation, and the Nemours Foundation

Kenney and Yee say that the federal funding structure could be changed from its current block-grant formula to one that rewards states with high participation rates in both Medicaid and SCHIP. Among other things, this would encourage states to address enrollment barriers and to adopt cost-effective outreach programs.

The authors also suggest increasing flexibility and funding to support automatic enrollment in SCHIP. “Given the fluctuations that occur in families’ incomes and circumstances, achieving anything close to 100 percent participation in SCHIP is likely impossible without some type of automatic or default enrollment mechanism,” they write. They also call attention to the barriers posed by recent federal legislation requiring proof of citizenship for enrollment and re-enrollment in Medicaid. The requirement could deter or prevent some eligible children from gaining coverage under both Medicaid and SCHIP, the authors say.

In addition, better information is needed about the quality of care under various SCHIP programs. Reauthorization could provide an opportunity to examine the costs of providing care for the program’s enrollees and a way to manage high-cost cases, the authors write.

The authors conclude that SCHIP could serve as a springboard for addressing broader health care issues for children and their families. For example, extending SCHIP to low-income parents could help reduce the overall number of uninsured Americans and improve the coverage, health and well-being of U.S. children. “Without greater federal subsidies for covering low-income parents, it is unlikely that their insurance picture will greatly improve,” say the authors.

Study: Low-Income Children More Likely To Be Limited By Chronic Conditions

In another study, researchers at Columbia University highlight disparities in health between poor and affluent children and call on policymakers to reduce income-related differences in care for poor children with chronic conditions. Only 70 percent of the 8.3 million children estimated to be poor between 2001 and 2005 were reported by their mothers to be in excellent or very good health, compared with nearly 87 percent of higher-income children, according to a study based on National Health Interview Survey data on 100,000 Americans by Columbia University economist Janet Currie and Wanchuan Lin of the University of California, Los Angeles (UCLA). http://content.healthaffairs.org/cgi/content/abstract/26/2/331

In addition, the incidence of low birthweight is higher than average in poor households, as is the prevalence of chronic conditions such as asthma and of mental health problems such as ADHD. The study found that 32 percent of poor children have at least one chronic condition, compared to 27 percent of affluent children. Poor children with chronic conditions are more likely to be limited in their activities than nonpoor children, especially when it comes to mental health issues. “If we are concerned about health disparities, we need to protect, expand, and restore funding for the treatment of poor children with chronic conditions,” the authors conclude.

Reforms Needed In Children’s Health

This issue of Health Affairs includes articles from leading health policy experts on a range of issues related to children’s health. Len Nichols, director of the Health Policy Program at the New America Foundation, writes that there is a moral case for society to provide health insurance coverage to poor children. http://content.healthaffairs.org/cgi/content/abstract/26/2/405

Lisa Dubay, an associate professor at the Johns Hopkins University Bloomberg School of Public Health, and colleagues examine the roles of Medicaid and SCHIP in providing coverage for children. SCHIP reauthorization provides an opportunity to revisit and improve Medicaid’s role in serving the nation’s most vulnerable children, they write. http://content.healthaffairs.org/cgi/content/abstract/26/2/370 (NOTE: The version of the Dubay article in the bound March/April volume contains some computational errors. For a corrected version, view the article online at the URL provided above.)

Sara Rosenbaum, chair of the Department of Health Policy at the George Washington University, and Paul Wise of Stanford University argue that the existing pediatric standard of coverage -- Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) -- has been jeopardized by the Deficit Reduction Act of 2005 and could severely hamper the quality of pediatric care, particularly for children with special health care needs. http://content.healthaffairs.org/cgi/content/abstract/26/2/382

Mireille Jacobson, an assistant professor in the University of California, Irvine, School of Social Ecology, and Thomas Buchmueller, a professor at the University of Michigan’s Ross School of Business, describe California’s innovative use of insurance brokers and tax preparers to enroll state residents -- particularly those at the upper end of the public insurance income scale -- in Medicaid and SCHIP. http://content.healthaffairs.org/cgi/content/abstract/26/2/538

Other articles in the March-April issue of Health Affairs explore policies for reforming child health care. Lead authors Neal Halfon, director of the UCLA Center for Healthier Children, Families, and Communities, and his UCLA colleagues call for broad reforms to the U.S. child care system such as establishing a federal Child Health Development Agency to consolidate existing funding and planning for children’s health initiatives. Halfon and his coauthors say that the U.S. system of child health services is so fragmented and underperforming that a new approach is needed to improve the system. “Realizing major health policy reform for our nation’s children not only is in their best interest but also is an important down payment on our country’s future,” they write. Other recommendations include improving early childhood services and systems, using health information technology to coordinate care among various health care providers, and organizing local child health development systems to manage care delivery. http://content.healthaffairs.org/cgi/content/abstract/26/2/315

Another paper in the March-April issue examines how society prioritizes the health of young people. Using the example of the allocation of flu vaccines during a pandemic, Daniel Eisenberg and Gary Freed of the University of Michigan argue that current methods for economic evaluation undervalue health interventions for the young and should be modified. http://content.healthaffairs.org/cgi/content/abstract/26/2/345


Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org.


©2007 Project HOPE–The People-to-People Health Foundation, Inc.