For a change, good news about health insurance

More low-income kids are covered. But some worry tight budgets could erase the gains.

As the ranks of uninsured adults continue to swell and worry over paying for medical care creeps closer to the top of American's list of concerns, there is some strikingly good news: The number of uninsured children decreased significantly between 1999 and 2002, the first time in a generation.

That's because single working mothers, such as Martha Lozada, who earns only $16,000 a year in a company that doesn't provide health insurance, now have access to the State Children's Health Insurance Program (SCHIP). Since its implementation in the late 1990s, almost 2 million more mostly low-income children have insurance coverage.

That still leaves almost 8 million children in the United States, or 10 percent, without health insurance, according to a study released by the Robert Wood Johnson Foundation Thursday. Of those, at least half are estimated to be eligible for low-cost or free healthcare coverage through SCHIP or Medicaid. Their parents just need to apply for it.

"We have to celebrate the good news in this report, mainly that there are more children insured," says Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation. "But we're very concerned about the gaps that remain ... and that some of those gains could be lost."

Cuts in some states

That's in part because the states' fiscal crisis is already having an impact on the expansion of healthcare coverage. In an effort to wrestle with spiraling Medicaid costs, 10 states have reinstated barriers or cut eligibility for coverage, making it more difficult for families to access health coverage, according to the Kaiser Family Foundation, a nonprofit healthcare think tank. This is coming at a time that companies in the private sector are reducing or eliminating health insurance altogether.

"For the most part, states have been reluctant to pull back on coverage because they know these families don't have any other options, but nonetheless a few states have started to pull back, some fairly dramatically," says Barbara Lyons, deputy director of the Kaiser Commission on Medicaid and the Uninsured. "So the outcome is that more families will become uninsured, and we know that results in poor access to care and poor quality of care."

The SCHIP program was one of the few major reforms that emerged from the failure of the Clinton healthcare initiative in 1994. Modeled after Medicaid, it offers federal matching grants to states that provide health insurance for low-income children. Like Medicaid, each state program is unique, with different levels of eligibility and coverage. When the program was first instituted in the late 1990s, few parents signed up. Studies determined that was because few knew about it, and a cumbersome and bureaucratic application process often discouraged those that did.

So many states started massive advertising campaigns and streamlined the application process. That has had an effect. The Robert Wood Johnson study, which was conducted by the Urban Institute, found that awareness about SCHIP among families in need increased from 47 percent in 1999 to 71 percent in 2002.

Ms. Lozada first heard about it when she was working in Florida two years ago at a company that didn't pay for insurance for her then 2-year-old son, but would allow her to buy it. The cost amounted to 40 percent of her salary.

"I just couldn't afford it," she says. "But I was constantly worried about him, because he suffers from acute asthma and could get an attack at any moment."

Lozada was forced to borrow money from her family to help pay his medical bills. She felt like a burden. Then her mother saw a commercial advertising Florida's SCHIP program, known as Florida Healthy Kids. She signed up.

"It made me feel at ease. He now gets regular checkups and meds," says Lozada, who's now moved to Washington, D.C., and is enrolled in the program there.

Benefits of enrollment

Low-income children who are enrolled in SCHIP or Medicaid are 1-1/2 times as likely to visit the doctor and dentist regularly as those that don't have insurance. Oxiris Barbot, medical director for the Bureau of School Health in New York City, says that can make a difference in a child's ability to learn and grow at school.

"From a number of schools we know that kids who are uninsured and have asthma tend to miss more school than kids who insured and have asthma, simply because they have access to medications," says Dr. Barbot. "We're now going to be tracking that on a citywide basis."

The city will also be taking part in a national back-to-school initiative to enroll as many as possible of the 4 million eligible but still uninsured low-income kids.

The initiative will focus particularly in the Latino community. The Robert Wood Johnson Foundation found that Hispanic children are "nearly three times as likely to be uninsured as white children and over twice as likely to be uninsured as black children," despite the gains.

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