1. New York: CHIP Waiting Period Not Good for Kids
Nationwide, uninsured children in families earning between $38,000 and $77,000 a year are just as likely to go without any health care as uninsured children in poorer families. More than 40 percent of children in those income brackets who are uninsured all year see no physicians and have no prescriptions all year, according to new research from the University of Rochester Medical Center.
"There's an assumption that children in families with higher income levels don't need insurance, that they are uninsured but are somehow still receiving health care anyway," said Laura Shone, Dr.P.H., M.S.W., an assistant professor of pediatrics at the University of Rochester Medical Center and author of the study. "This study shows that in reality, a large percentage of these children don't receive any care at all--which pediatricians say is unacceptable, and parents know is unrealistic. Even healthy, older children need to see their physicians at least once over the course of a year."
A waiting period to qualify for the State Children's Health Insurance Program (CHIP), a federally funded program offering health insurance to low-income children not eligible for Medicaid and without private coverage, doesn't address chronic health conditions such as asthma, the study finds. Thirty-five states require uninsured children to go without insurance for a period of time before they can enroll in CHIP.
"First of all, we've found that few families switch their children to CHIP when they have the option of private health insurance...in fact, only 7 percent do," study author Laura Shone, an assistant professor of pediatrics at the University of Rochester Medical Center, said in a prepared statement. "Second, those who do switch have the same unmet health-care needs as those who didn't have (health) insurance when they enrolled," Shone concluded.
Her team's findings are based on research done on New York's Child Health Plus CHIP plan. Child Health Plus has never instituted a waiting period, giving researchers an opportunity to study the patients who switch from private insurance. Shone said this study shows that families are not "saving up" health problems to address after enrollment in CHIP.
Earlier research by this team has shown that Child Health Plus greatly increases children's access to primary care, preventive care, as well as other needed health care. CHIP markedly reduces children's unmet health care needs and reduces pre-existing racial disparities in access, unmet need and continuity of care. Parents of children with asthma and special health care needs were more satisfied and better able to afford care and medications for their child's condition once enrolled. [University of Rochester Medical Center 05/03/08 and HealthDay News 05/05/08]
2. National: Failing Economy Predicts Worse Health
Health care in the U.S. is expensive. That much is plain to many Americans these days. But as the economy spirals downward, a series of recent reports forecasts that the country's health-care crisis is about to get worse, particularly for children. A study conducted at Cincinnati Children's Hospital Medical Center and released Saturday analyzed data on more than 15,000 children in Ohio, and found that kids who did not have continuous health insurance were 14 times less likely to have regular visits with a pediatrician than those who did. They were also three times less likely to fill prescriptions for necessary medication. "These unmet medical needs directly put a child's health at risk," says Gerry Fairbrother, a researcher on health policy at Cincinnati Children's.
In a second study, Fairbrother concluded that children who were covered by private insurance were over three times more likely than government-insured children to lose their coverage if a parent lost or quit a job. That's a scenario increasingly familiar to Americans. "Higher unemployment figures mean more and more families are ending up uninsured now," Fairbrother says. Moreover, she adds, they're not getting access to the public insurance to which they're entitled, because of budget cuts. "The federal government needs to fund its health-care programs in a way not so exposed to economic cycles."
That's not likely to happen any time soon. Leading health researchers at the Urban Institute on April 29 warned that each percentage-point rise in unemployment would result in an additional 1.1 million people losing health insurance; add that to the 47 million Americans who are currently uninsured. Virtually all of those newly uninsured will be forced to enroll in Medicaid or the State Children's Health Insurance Program (CHIP), the government's primary low-income health plans. To support the growing registry, these health plans will need $3.4 billion in additional funding, at least $1.4 billion of which will have to come from state legislatures. But the extra money will be difficult to collect, as states' revenues and the economy continue to shrink. Nearly 30 states are already forecasting budget shortfalls for the coming year exceeding $39 billion. "Most states at this point simply can't afford to give any additional people health care," Fairbrother says.
More and more, workers can barely afford to keep it. In recent years, most people have seen larger chunks of their paychecks going to health-insurance premiums. Indeed, premiums have increased 10 times faster than incomes, according to a study released by the Robert Wood Johnson Foundation last Wednesday. In 2005, the average American family paid 30% more for health coverage than it did in 2001, while incomes rose only 3% in the same period. In dollar figures, that's a $2,500 price increase each year. What's more, the study found, the number of private companies offering health benefits to employees shrank by 30,000. "Providing insurance coverage takes a bigger bite from the family budget every year," says Robert Wood Johnson's CEO Dr. Risa Lavizzo-Mourey.
It's a situation that has driven Americans to new extremes. Some 7% of people polled by the Kaiser Family Foundation in April reported that one member of their household got married to a health-insured person within the past year just to get a piece of the benefits. More commonly, however, families went without medical attention. Twenty-nine percent of people said they'd put off necessary care, 24% had delayed a medical test or treatment and 23% said a prescription had gone unfilled. But none of this is surprising when you consider that one in three people surveyed also said they or their family had had serious trouble paying for health care over the past year. "Many people view health and the economy as separate issues," says Kaiser CEO Drew E. Altman. "But the cost of health care is a significant pocketbook issue for many families." [Kathleen Kingsbury, Time, 05/05/08]
3. Maryland: Letters Notify Families Who Might Be Eligible
Inspired by Howard County's success in finding uninsured children eligible for federal health coverage, state officials are launching a search of their own. Health officials are preparing to mail notices to tens of thousands of people across Maryland whose family members might be eligible for a federal program that provides access to affordable health care. A bill approved this month by the General Assembly directs the comptroller's office to review state tax information to determine who might be eligible and then notify the families.
The statewide initiative comes on the heels of the comptroller's office sending more than 21,000 letters on behalf of Howard County. Mailed two weeks ago, the letters were a part of Howard's new plan to begin providing access to health care for uninsured county residents, including 5,000 children. Part of that plan is to use existing programs that people might not know about, such as the federally funded State Children's Health Insurance Program (CHIP). In addition to recruiting more uninsured children, state health officials said a second mailing will be conducted to notify families that are newly eligible for Medicaid following General Assembly approval of expanded eligibility criteria.
The Howard County program hopes to enroll about 2,000 people the first year And use data collected in that first year to guide expansion and help other local governments that want to replicate the plan, called Healthy Howard. The county, which has a population of about 271,000, received more than 550 responses in the two weeks since its office sent letters notifying residents of possible eligibility for CHIP. The letters went to residents with incomes less than 300 percent of federal poverty levels, which is Maryland's eligibility ceiling.
The eligibility criteria for CHIP could face modification in the near future. The Bush administration is pushing to limit access to the program to families with incomes less than 250 percent of federal poverty levels, and federal regulations call for "corrective action" by August 2008 if states don't conform. But John G. Folkemer, a deputy state health secretary, said that because there is both a lawsuit and congressional legislation pending to reverse or delay the Bush administration rules, the state will not change practices at this point. [Larry Carson, Baltimore Sun, 04/16/08]
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