As children and families continue to lose employer-based health insurance due to the economic downturn and the ballooning cost of coverage, federally- and state-funded children’s health programs have stepped into the gap to prevent more children from going without health coverage. Between 2007 and 2010, nearly half a million California children lost private health insurance, while over 600,000 additional children enrolled in public programs. These programs should be expanded and improved, and outreach to families should be increased so that every eligible child is enrolled. The added public expenses associated with uninsured children—including increased reliance on care at the emergency room, missed school days, and missed parental work days—are unaffordable.
When children have health insurance, they are more likely to receive routine preventive and primary health care, which protects them from avoidable diseases and facilitates early diagnosis and treatment when they are sick. Without health insurance, families often forgo preventive care, accessing health care only when their children are seriously ill. As such, illnesses that could have been treated easily at earlier stages become much more severe. In addition to undermining children’s health, this delayed approach to care costs the public significantly more than preventive services, as care is often accessed through expensive emergency care providers.
Throughout the late 1990s and 2000s, California made steady progress to increase the percentage of children with health insurance. Between 1999 and 2010, the number of California children without coverage decreased by approximately 580,000, from 17% to 11%. Over the past few years, however, the California budget has included shortsighted cuts to funding for Medi-Cal and Healthy Families. For example, premiums for children enrolled in Healthy Families have been increased several times, making it harder for families to keep their children covered.
In addition, California has slashed funding for the Healthy Families Program, relying on short-term funds from the federal government, health plans, hospitals and First 5 California to fill the gap. When these short-term funds are no longer available, the state will need to act quickly to ensure that critical children’s coverage programs are adequately supported.
California cannot afford to let the ongoing budget crisis cloud its judgment of the benefits of providing public health coverage to all children who need it. The state should build on the re-authorization of the federal Children’s Health Insurance Program (CHIP) in early 2009 and passage of the Affordable Care Act in 2010, both of which reflected and reiterated a commitment to children’s health coverage. Moreover, California can learn from other states: even in tough economic times, 23 other states implemented changes or enacted legislation to increase the number of children and families receiving health coverage through Medicaid and CHIP. California was one of only three states that enacted policies to cut children and families from Medicaid, CHIP or both in the same time period.
Given a full economic recovery is projected to take several years, California must prioritize a long-term, sustainable approach to ensuring every child has access to affordable health insurance.
On March 23, 2010, President Obama signed the Affordable Care Act (ACA) into law, and it’s already improving health coverage and access for millions of California’s children and young adults.
As a result of the ACA, over 1.1. million Californians under 25, who have pre-existing health conditions like asthma or diabetes, can no longer be denied coverage, and approximately 200,000 California young adults under age 26 will gain coverage through their parents’ employer-sponsored insurance. In addition, many of the nearly 6 million California children under age 19 with private coverage will no longer have co-payments for preventive services; annual dollar or lifetime limits on coverage; or the risk of coverage being taken away (“rescinded”) when they get sick. Finally, 4.5 million children can rely on their Medi-Cal or Healthy Families coverage because of the ACA’s stability, and there are renewed efforts to sign up the nearly 700,000 children who are eligible but not yet enrolled in Medi-Cal or Healthy Families.
The ACA will strengthen health care for California’s children and families even more when it is fully effective in 2014, with additional provisions such as the California Health Benefit Exchange marketplace and enrollment portal. The state must match the federal commitment to improving health care by ensuring that implementation of the ACA in California guarantees affordable, comprehensive, high-quality health coverage for all of the state’s children.
On February 4, 2009, President Obama signed the Children’s Health Insurance Program (CHIP) reauthorization bill - H.R. 2 (CHIPRA 2009). With the successful passage of CHIPRA 2009, Congress and President Obama demonstrated a strong commitment to covering the nation’s uninsured children. This federal leadership on children’s health gives California an opportunity to draw on federal funding to provide health coverage for the roughly one million uninsured children in the state.
Community-based organizations in the state won federal outreach grants to improve enrollment of eligible children. But California leaders have the responsibility to do their part to capitalize on the newly available federal funding for children’s health insurance. If they fail to do so, CHIP funds will be distributed to other states and California’s children will be needlessly left out.
Download a brief summary of the key provisions in the CHIP reauthorization bill and recommendations for California to take advantage of the opportunities in the legislation.