ENDGRAM

Emerging Child Health insurance:
A Window of Opportunity

An invited editorial by Barbara A. DeBuono, M.D., M.P.H.

Let’s look into our crystal ball and predict the health of our nation’s children. for those with access to health care coverage, I see healthy children ready to learn, prepared for young adulthood and a productive fulfilling life.

for those ten million uninsured children, I see unmanaged chronic illness, visits to emergency rooms, absences from school, struggles to obtain a high school diploma and an uncertain future.

In New York State and this nation we have an opporuntity to change that; to bring every child into the medical care system to assure an outstanding future. We are ahead of the game in New York because we can build on the success of our subsidized health insurance program for children of the working poor, Child Health Plus.

Child Health Plus provides a comprehensive benefit package through an innovative public-private partnership. Children receive the primary and preventive health care they need to assure them a healthy start in life including doctor visits, immunizations, prescription medicines, x-rays and emergency room visits.

Since 1990, New York’s Child Health Plus has evolved into an important laboratory for determining whether government can assure children access to quality health care. Early on, the program provided subsidized outpatient health insurance for children under age 13 in low income families. Later legislation expanded Child Health Plus to eligible children up to age 16.A statewide, independent evaluation of the program in 1996 by the University of Rochester found that it has been successful in increasing access to health care, particularly primary care, and in improving the health status of children in needy, working families.

Additionally, the program’s emphasis on preventive health care, including immunizations, helps New York increase what is, according to the Centers for Disease Control and Prevention, one of the highest immunization rates of any large state.

This year Governor George E. Pataki significantly expanded Child Health Plus, adding hospitalization to the services covered, increasing eligibility to children through 18 years of age and increasing state spending. State funding for the program has swiftly increased from $55 million for 77,000 children in 1994 to $207 million for 251,000 children by the end of 1999. Last year Congress enacted an enormously productive advance in health care for children, The Children’s Health insurance Program. It plans to spend $48 billion on it over the next decade.

This is when the crystal ball comes in. With New York’s program already serving as a model for the nation, and the federal government now on board to support state programs, things suddenly became quite clear. This is the decade of opportunity for our country to expand health coverage and create a nation of healthy children.

New York has the nation’s largest program of its kind and one of the oldest. At a time when the federal government is looking to the states for policies that work in expanding children’s health insurance, New York’s experiences offer critical lessons on the challenges and results other states might expect.

With the additional federal funds, New York will markedly expand Child Health Plus to give nearly all of its estimated 420,000 uninsured children hospitalization coverage and primary and preventive health care. Governor Pataki plans to include vision, dental, speech and hearing and provide free coverage for children in families with incomes less than 160 percent of the federal poverty level.

However, with this great expansion comes great challenges. New York knows that merely offering children health insurance does not automatically produce healthy children. We have learned that in order to reach as many of the eligible families as possible, we must conduct very targeted outreach efforts.

In mid-1997, a $1 million marketing and outreach campaign was initiated to boost enrollment. as a result, we were able to guide more than 6,000 children per month into the program, up from approximately 1,200 per month prior to the marketing effort.

Federal funds will allow the state to increase its spending on marketing and outreach. in the meantime efforts are underway to gain the support of private business and the educational community to help get the word out; supermarkets are offering to print advertisements on their grocery bags and educators will be holding enrollment nights in school gyms.

Another challenge is maintaining the delicate balance between family income eligibilities. Child Health Plus is currently available at a subsidized rate to families that have net incomes of 222 percent of the federal poverty level. While some advocate raising this threshold, the danger in raising the income eligibility too far is that it could provide incentives for employers to drop coverage—something we hope to avoid.

to date New York has rescued 160,000 children from the land of the uninsured. and this number grows every day. Our goal is to provide every child in New York with a medical home where they will receive high quality health care. and so, in contemplating the future, I envision a country of healthy children with access to high quality affordable health insurance. Just as it has been possible for us in New York to develop a program that efficiently and effectively extends coverage to our state’s children, I believe it is possible to develop such a program for our nation’s children.

Barbara A. DeBuono is Commissioner of Health for New York State.