Health Insurance

Six years after the State Children’s Health Insurance Program
(SCHIP) began, federal and state governments are spending
roughly $40 billion on health care coverage for disadvantaged
children. What does the latest research have to say about the
effectiveness of these efforts? The David and Lucile Packard
Foundation has just released a new report, “Health Insurance
for Children: Issues and Ideas,” which discusses important
facts about SCHIP and Medicaid as well as policy options for
states dealing with uninsured children. This article discusses
findings from the report.
Is children’s health insurance a private or
public issue?
Children’s health insurance is a private issue because
uninsured children can place stress on families. In a recent
study, nearly three-quarters (74%) of parents whose children
were newly insured reported feeling worried, scared, and
stressed when their children lacked insurance (Lave et al.,
1998). More than a third (36%) of these same parents reported
financial difficulties as a result of out-of-pocket medical
expenses for their uninsured children (Lave et al., 1998).
Children without insurance are a public issue as well. In
California, a study found that publicly insured students
experienced a 68% improvement in “paying attention in class”
and “keeping up with school activities” (Children’s Health
Assessment Project, 2002). In Texas, almost two in ten (19%)
families without insurance used emergency rooms—the
most expensive sources of care—as their primary venue for
treatment. After enrolling in public insurance programs, this
number fell to only 1% (Shenkman et al., 2002).
Do public health insurance programs reach
all who need them?
Public health insurance programs have been successful in
reaching children and families in need. The most recent census
data show that 16.5 million children (about a quarter of all
children nationwide) received either Medicaid or SCHIP
coverage. Nonetheless, an additional 8.5 million continued to
lack insurance. Of these children, more than three-quarters (76%)
were eligible for either Medicaid or SCHIP, but were not enrolled.
Some of the barriers to getting eligible children insured are
bureaucratic. In a 1999 survey, 27% of parents with eligible
children said they had never heard of SCHIP, thought that their
children were not eligible, or did not have the information they
needed to apply. One in ten said they did not apply because
of the administrative hassle involved (Kenney et al., in press).
Eligible children in immigrant families are often not enrolled
due to their parents’ language barriers, difficulty understanding
eligibility and program rules, or fear of repercussions for using
public benefits (Lessard and Ku, 2003). For legal immigrant
children, federal benefits are not available until they have
lived in the U.S. for five years, although states are allowed to
use their own money to pay for health care coverage (National
Immigration Law Center, 2002).
How are governments funding programs to
insure children?
According to this report, the federal government could aid
states in reducing the numbers of uninsured children by
improving how SCHIP and Medicaid are funded. While an
additional $6.1 billion is available to states to enroll eligible
children not yet receiving coverage, states would need to raise
$3.7 billion in matching funds to get these federal monies. In
the current economic climate, with governors projecting 2003
state budget deficits of $30 billion and 2004 deficits up to $80
billion, meeting this goal looks daunting. What’s more, funding
for SCHIP for the 2002-2004 biennium is reduced by more than
a quarter (26%), which translates to about $1 billion per year.
With a three-year expiration date on unused federal dollars for
SCHIP, almost $3 billion could be returned to the U.S. treasury
as early as September 2003. Given these conditions, states are
scrambling even harder to fund Medicaid and SCHIP, at the
same time that demands for these programs are on the rise.
What policy options exist to enroll
uninsured children and fund public
programs?
The Future of Children report features a number of policy
options to both increase enrollment of low-income children
and to expand and strengthen public insurance programs
during troubled economic times. Funding improvement
options include using Medicaid and SCHIP funds for
“premium assistance,” where low-income families use
public funds to pay premiums on their employer-sponsored
insurance. This type of program, which currently exists in
Iowa, Maryland, Massachusetts, and Rhode Island, can cost
governments less than providing full coverage on their own.
The report also discusses the possibility of counter-cyclical
funding mechanisms that would increase federal dollars for
public health insurance when state budgets are limited in
their spending. Lastly, the report considers whether Congress
could stop unspent SCHIP monies from being returned to the
Treasury, and instead mandate that they be held or used to
insure more eligible children.
Additionally, this report includes numerous examples of
the ability of states’ programs to reach, enroll, and retain
low-income children and their families. Nine state program
directors report about how they have structured innovative and
effective SCHIP programs. Appendices provide state-by-state
data, program profiles, relevant web-sites and organizations,
and the names and contact information of experts in the field.
For more information on this report, or to order a copy, please
contact Beth Gross at 608-262-5779, or by e-mail at egross@
ssc.wisc.edu of the Wisconsin Family Impact Seminars.
This article is based on: Behrman, R. E. (Ed.). (2003). Health
insurance for children: Issues and ideas. The Future of
Children, 13(1). Available at: http://www.futureofchildren.
org/homepage2824/index.htm
Connecting with UW Faculty
Questions on health care and health care policy? Contact:
Professor and Extension Specialist
Roberta Riportella-Muller
Roberta Riportella-Muller is an Associate Professor of
Consumer Science at UW-Madison and a Health Policy
Specialist in University Extension. She is the Project Director
of Covering Kids and Families, a Robert Wood Johnson
Project to assure enrollment in BadgerCare for eligible
Wisconsin children and their parents. Roberta is involved with
the development of an educational curriculum for Medicare
beneficiaries. She has directed the Local Family Impact
Seminars. She studies health care and health care access.
Contact her at: rriporte@wisc.edu or (608)263-7088, or visit
her health policy website at: http://uwex.edu/ces/flp/health.
Family
Studies
Center for Excellence in
School of Human Ecology • UW-Madison
Family Matters is a newsletter for state policymakers
published by the Wisconsin Family Impact Seminars
(WISFIS). WISFIS connects research and policymaking, and
examines the impact of policies on families. The seminars
provide objective, state-of-the-art information on a range of
policy options. WISFIS is a joint effort of University of Wisconsin-
Extension and the Center for Excellence in Family Studies in the
School of Human Ecology at the University of Wisconsin-Madison.
This newsletter was written by Beth Gross, and Karen
Bogenschneider. The designer is Meg Wall-Wild. The director
of WISFIS is Professor Karen Bogenschneider and the state
coordinator is Carol Johnson.
For further information, contact the Family Impact Seminar Office
at (608)262-5779, fis@ssc.wisc.edu, or Karen at (608)262-4070,
kpbogens@wisc.edu. You can access WISFIS briefing reports on
the web at:
http://www.uwex.edu/ces/familyimpact/wisconsin.htm
Family Matters is on the web at:
http://www.uwex.edu/ces/familyimpact/newsletters.htm
This newsletter can be copied and distributed without permission. Please
notify the authors of how this newsletter is used.
Rhode Island Helps
Low-Income Families with Employer
Insurance Premiums
With health care premiums on the rise, many low-income
working families are turning down employer-sponsored
insurance because they cannot afford to pay their share. In
Rhode Island, a new state program called RIte Share provides
premium assistance to Medicaid-eligible families. Program
staff use a two-step process to determine enrollment. Because
RIte Share sets standards for comprehensive insurance, they
first assess whether the employer’s insurance plan measures
up. Next they compare the cost of paying the employee’s
premium to the cost of enrolling him or her in the state
Medicaid program, RIte Care. To cut down on administrative
time, Rhode Island uses an average cost per RIte Care family
to determine cost-effectiveness. Families are enrolled in RIte
Share if the cost of their premium is less than what the state
pays to cover the average family under RIte Care.
After early trouble with employers’ complaints of administrative
burdens, RIte Share now reimburses employees directly for
their share of premiums, rather than asking employers to accept
payments from the state. Since making this change, enrollment
in the program has grown considerably. As of February 2003,
RIte Share’s enrollment is at 3,500.
For more information on the RIte Share program, contact:
Kate Brewster, Manager
Employer Contact Unit, RIte Share
401-462-0318
kbrewster@gw.dhs.state.ri.us
http://www.dhs.state.ri.us/dhs/famchild/shcare.htm
This article is based on: Behrman, R. E. (Ed.). (2003). Health
insurance for children: Issues and ideas. The Future of
Children, 13(1). Available at: http://www.futureofchildren.
org/homepage2824/index.htm
Who is Uninsured In Wisconsin?
Approximately 380,000 Wisconsinites—about 7% of the
state’s population—lack health insurance according to recent
data (Family Health Survey, 2001). Who are the uninsured in
Wisconsin, and how are they influencing and being influenced
by the current economy and political climate? Professor Roberta
Riportella-Muller, Extension Health Policy Specialist, provides
the following snapshot of the uninsured in Wisconsin.
The poor are at risk. More than half of Wisconsin’s
uninsured population (202,000) is made up of low-income
individuals and families (Family Health Survey, 2001).
Children who are African American, American Indian, Asian,
or Hispanic suffer disproportionately from poverty.
Children are at risk. In spite of programs like Medicaid,
Healthy Start, and BadgerCare, 68,000 children
eligible for health insurance benefits in Wisconsin
are still uninsured (Family Health Survey, 2001).
The rural are at risk. Wisconsin’s rural
residents are at a higher risk of being uninsured than those
in metropolitan areas. In 2001, Wisconsin’s Family Health
Survey reported 10% of Wisconsin farm families as being
uninsured (Family Health Survey, 2001). A more recent report
from Extension indicated that number is higher: 20% for dairy
farm families (Program on Ag Tech Studies, 2002), with 25%
of farm families having at least one family member uninsured.
The unemployed are at risk. Current economic conditions,
combined with rising health care costs, has led to an
increasingly large group of workers at risk of not having
insurance. From June 1999 to June 2002, the state’s
unemployment rate grew 75%, rising from 2.8% to 4.9%,
which was double the pace for the nation as a whole (Center
on Wisconsin Strategy, 2002). The statewide unemployment
rate in Wisconsin in March 2003 stood at 6.5% [Department
of Workforce Development (DWD), 2003]. Total employment
has actually decreased in the last year and a half, reversing
a long time trend of employment growth. In the first four
and half months of 2003, more than 8,000 workers received
layoff/plant-closing notices in Wisconsin; in 2002 nearly
16,000 workers received such notices (DWD, 2003). Without
employer-sponsored insurance, many of these workers—and
their families—run the risk of being without the means to
receive and pay for health care.