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Problems Remain Insuring Children

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WASHINGTON, Dec 09, 2003 (United Press International via COMTEX) -- The government has made progress ensuring America's low-income children have access to healthcare coverage, yet research finds millions of youngsters still do not have health insurance and adequate medical treatment.

The findings, presented by the Alliance for Health Reform and The Commonwealth Fund, two non-partisan, nonprofit organizations that work to improve healthcare, show 9.2-million Americans under the age of 19 -- about 12.1 percent of the total United States population -- went without health insurance in 2001.

Dwindling state budgets, enrollment barriers and inconsistent medical care all contribute to the problem, a panel of experts reported.

"We are really very much at a crossroads right now," said Cindy Mann, a research professor at the Georgetown University Health Policy Institute in Washington.

Federal and state health insurance programs, such as Medicaid and the State Children's Health Insurance Program or SCHIP, have reduced significantly the overall number of children going without healthcare coverage, Mann explained, but the economic pinch of the past few years has forced states to struggle to continue financing these programs.

"We're losing ground," Mann said, adding it was "largely because of budget pressures."

Medicaid is run by the states, but the federal government provides matching money to help fund the programs. Medicaid is expected to spend $304 billion in 2004, a five-fold increase since 1989, surpassing Medicare for the first time and becoming the largest government healthcare entitlement program.

SCHIP is a program begun by the Balanced Budget Act of 1997 that allows states to expand their Medicaid programs to provide health coverage for the so-called working poor -- children and families that might not otherwise qualify for the traditional program. All 50 states have such programs and they also have the option of using federal government matching money to create a SCHIP option with private insurers outside their Medicaid program.

Higher premiums and co-payments also have hurt working families and "can have a dramatic impact" on whether they can get health care for their children, Mann said. "Public policy decisions make a big difference," she noted.

The data show seven states have closed federal and state health insurance program enrollment for children, placing thousands of kids on waiting lists, Mann said. Enrollment freezes in other states have forced families to juggle medical needs on their own, such as sharing antibiotics for multiple uses or using old medications for new ailments.

States will continue to feel the pinch in the coming years. Nine states are projected to exhaust federal SCHIP dollars by 2005, Mann said.

A surging elderly population on Medicare, with increasing medical needs, also will siphon Medicaid resources. At present, 42 percent of Medicaid spending or $91 billion goes toward services for Medicare beneficiaries.

"Children are not an expensive population to cover," said Sarah Shuptrine, founder, president and chief executive officer of the Southern Institute on Children and Families, an independent nonprofit group based in Columbia, S.C.

She presented data showing children only accounted for 18 percent of Medicaid expenditures in 2002.

Money is not the only problem facing low-income families trying to get healthcare coverage for their children. Enrollment is a major hurdle. Shuptrine said 51 percent of kids in America are eligible for Medicaid and SCHIP, but are not enrolled, making almost 4 million children unnecessarily uninsured.

The key is to simplify the enrollment process, Shuptrine said, and added while not all states have improved in this area strides have been made in some pockets of the country.

For example, 45 states and the District of Columbia no longer require face-to-face interviews as part of the initial enrollment process. This is a huge benefit since working parents would lose pay by taking time off to come in for interviews, Shuptrine said.

Forty-three states and the District of Columbia require no asset test, but seven states still do. A poor working family with a house or a car could have problems getting healthcare coverage for their children.

"That is counter-productive public policy," Shuptrine said.

Most states also have made the renewal process easier to avoid disruption in services, however Shuptrine said now is not the time to let up on those efforts.

"We must keep a firm grip and keep the states committed," she said.

Dr. Edward Schor, director of the Program for Child Development and Preventive Care for The Commonwealth Fund in New York City, said states also must focus on improving the quality of preventive care that children on Medicaid and SCHIP receive.

"We need to be paying much more attention to the quality because we have a significant problem there," Schor said. "The first three to six years of (a child's) life are really critical."

Dental and mental health care too often are overlooked as well, Schor explained. Another critical problem is the transition period getting teenage children to maintain their medical care as they become young adults. Schor said too many young people drop out of the system after reaching their upper teens.


Katrina Woznicki covers medical issues for UPI Science News. E-mail

Copyright 2003 by United Press International.

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