Children's health insurance: bracing for cutbacks*

It's a case of the good news being reported right before the ax falls. Providing children with health insurance makes a huge difference in whether kids receive the care they need, especially if they are chronically ill with such things as asthma or diabetes. The Robert Wood Johnson Foundation released a state-by-state report today, "A Needed Lifeline." The report was conducted by researchers at the University of Minnesota.

Insured children are three times more likely to have visited a doctor's office in the course of a year than are uninsured children, according to the report. About 60% of insured children are covered by private insurance plans, and about a third of children are covered under public programs, such as Medicaid (MediCal in California) or the State Children's Health Insurance Program (SCHIP). The L.A. Times, on Nov. 26, 2007, wrote about how the children's program can affect even middle-class families. The new report shows that although 41% of chronically ill kids who had no health insurance skipped needed care, only 10% of those covered under public programs skipped needed care.

"When children who need care do not receive it, their conditions worsen and are harder and more expensive to treat later," Dr. Risa Lavizzo-Mourey, chief executive of the Robert Wood Johnson Foundation said in a press release. "Because of Medicaid and SCHIP, millions of kids can get regular check-ups, take the medications they need to stay well and see a doctor when they are sick."

That's the good news. The bad news is that some states, including California, might be scrambling to stall new enrollments, or even un-enroll some kids from public insurance programs, because of a new set of rules set down by the federal Centers for Medicare and Medicaid Services.

It gets pretty complicated, especially here in California, which has the nation's largest SCHIP program, known as Healthy Families. But the California HealthCare Foundation has laid out the state's options in a report called "SCHIP at the Crossroads: Options in Responding to New Federal Funding Conditions." 

The program covers about a million California children and mothers in families earning up to 250% of the federal definition of poverty, or $52,500 for a family of four. Efforts to enroll more children, in families earning more than that, have so far failed. But the state has used its authority to expand the program and enroll additional children by overlooking certain types of income, or offering credit for certain expenses, such as child care.

Last year, a federal directive with an Aug. 18 deadline came down from the Centers for Medicare and Medicaid Services that put some aspects of California's program at risk. For example, some county programs -- with federal permission -- that have enrolled children in families earning 300% of the federal poverty level may lose that permission for new enrollees. And all newly enrolled children must be uninsured for a year to qualify, according to the new rules. The old rule said they had to be uninsured for only three months before they could be signed up. Yesterday, the state decided not to comply with the new rules, according to CQ Healthbeat, saying that key requirements run counter to California law.

Congress has voted several short-term extensions of the SCHIP program, the most recent to expire in March 2009. But between now and then -- you may have noticed -- there's a general election, and state agencies can't be sure what will happen to programs for uninsured children. On top of that uncertainty, the new CMS rules have just about everyone scratching their heads.

So the SCHIP program, a success story in dropping the number of uninsured children from 11.1 million in 1998 to 7.9 million in 2004, has just received yet more evidence of its value from the new Robert Wood Johnson study. But with the deadline for the new CMS rules just four days away and no one certain how the feds will respond to California's refusal to comply, with a change in president certain, and possible changes in every other elective office in the land, is it any wonder that states just don't know what to do about the millions of children who are still uninsured?

If you need a laugh after reading through these see-sawing public policy changes, check out The Onion's satirical take on children's health insurance. Fake pollsters said they asked 2,000 children what they wanted. And the vast majority of kids ages 3 to 8 were adamantly opposed to any kind of healthcare. They didn't want shots, trips to the doctor, medicine or hospital stays. 

-- Susan Brink

Photo: John Moore/Getty Images  Lardon Clifton, 5, awaits care at a free traveling clinic, Remote Area Medical clinic, in Wise, Va.