1. Alaska: Need Innovative Children's Health Plan
Every day young people come into my office at Covenant House seeking help for a variety of health problems. Some have minor illnesses such as bronchitis. Some need mental health services. Some have life-threatening illnesses such as leukemia or diabetes. Finding a payment source that allows these young people to obtain the health care they need is one of my main challenges.
It is estimated that in Alaska 13.4 percent of the children ages 0-18 have no health insurance. Most of these children come from working families who earn too much to qualify for Denali KidCare, yet can't afford to purchase health insurance on their own. Overall 84 percent of Alaska's uninsured individuals are in working families.
For a mother in her thirties with two young children to purchase private insurance in Alaska could cost $785 a month or $9,420 per year. For a family earning $40,000 a year this would equal nearly a fourth of their income. Instead of paying this amount, families decide to take a chance that they won't have anything serious happen. I always warn people that a broken leg alone can cost you over $20,000. Families with children with serious illnesses, such as diabetes, may not be able to find private insurance at all because of "preexisting conditions."
At the national level, the current strategy to reduce the number of uninsured is to put together a patchwork of coverage. Programs such as Denali KidCare are one of the main components. Denali KidCare is attractive to states because 65 percent of the cost is provided by the federal government. This legislative session several bills are being considered that would make Denali KidCare available to more Alaska children and pregnant women. Sen. Bettye Davis has sponsored SB 13, which would raise the income eligibility to 200 percent of the federal poverty line. (Most states have opened their children's health insurance program further than that, to get as many of the children covered as possible.).
Anchorage Sen. Bill Wielechowski has introduced SB 87, which would expand Denali KidCare to children in families with incomes up to three times the federal poverty level. Families with incomes between the 200 percent to 300 percent of the federal poverty level would pay a premium ranging from $240 to $1,200 per year. On the House side, Rep. Mike Hawker introduced a similar plan, with an annual premium paid by families with incomes in the 175 percent to 250 percent of the federal poverty level. Gov. Palin has publicly supported restoring eligibility back to 200 percent of the federal poverty level. This would provide an additional 1,300 children and 225 pregnant women with coverage.
As Alaska tackles the problem of finding health insurance for all its residents, we need to be flexible and innovative. Our first efforts should be to find coverage for our children. Providing them with a healthy start to life has the biggest payoff in the long run. During childhood, the patterns are set that last a lifetime. Having healthy children increases their ability to communicate and learn, to exercise and play and have a positive outlook on life. I encourage you to contact your legislators and the governor and voice your support for increasing health coverage in Denali KidCare. [Pat Senner, Anchorage Daily News, 02/24/09]
2. Mississippi: Eliminating Retention Barrier Is Cost Effective
House Bill 105 removes requirements for children 16 and younger to attend in-person interviews to re-enroll in CHIP. A recent federal heath insurance expansion offers financial incentives for states that enroll more kids who are eligible. Critics say the face-to-face mandate is a barrier to health care. An inadequate number of offices with limited hours of operation make it difficult for working parents to re-enroll their kids, advocates said.
Barbour and Medicaid officials have defended the requirement as a way to reduce fraud and educate enrollees. In a news release issued before the vote, the Republican governor touted a low error rate in fraudulent payments for Medicaid and CHIP. “Requiring face-to-face meetings to check a recipient's eligibility has reduced fraud and improved the efficiency of Mississippi's Medicaid program,” he said.
Advocates said millions of dollars spent on administering face-to-face meetings have resulted in tens of thousands of children being removed from CHIP, and many were reenrolled later. “That same $80 million, if used to match federal funds, would bring Mississippi $320 million for working-poor and middle-income families in this state,” said Oleta Fitzgerald, director of the Children's Defense Fund's Southern Regional Office. [Natalie Chandler, Clarion Ledger, 03/06/09]
3. Alabama: Health Insurance Rolls May Increase in All Kids
The recent federal reauthorization of a program that fills the health insurance gap for children could be a boon for Alabama, and state officials say it couldn't have come at a better time. Last month, Congress passed the Children's Health Insurance Program Reauthorization Act of 2009 in an effort to help states significantly expand their pro-grams and eventually provide health insurance to 11 million low-income children. The program currently serves 7 million and could expand by 4 million by the time it is reauthorized in 2013.
Alabama's program, which is known as All Kids, has about 71,000 children on its rolls more than 6,000 of whom live in the tri-county area, but director Cathy Caldwell said the reauthorization makes room for those numbers to grow. And there are plenty of youngsters in the state who could benefit. "It definitely provides adequate funding for us to continue enrolling children," she said. "We still have many, many uninsured children who are either eligible for Medicaid or All Kids." In fact, there are about 78,000 children in Alabama who are uninsured. Of those children, 40,000 to 45,000 are eligible for Medicaid and 15,000 are eligible for All Kids.
Aimed at children whose parents make too much money to qualify for Medicaid but too little to qualify for private insurance, All Kids can cover children from birth to their 19th birthday, Caldwell said. To be eligible for All Kids, a family's income has to be above the Medicaid level and up to 200 percent of the federal poverty level, which is about $42,000 for a family of four.
Todd Stacy, deputy press secretary for Gov. Bob Riley, said the governor was pleased that Congress reauthorized the pro-gram. When Congress attempted to re-authorize the program and failed in 2007, Riley went to bat for Alabama's program, though the state's Republican congressmen and then-President George W. Bush were against it. Riley wrote letters to the men asking them to reconsider their position and the good that the program was doing in the state.
Stacy said although the governor is happy with the 2009 version of the State Children's Health Insurance Program (CHIP), he would not be in sup-port of it being expanded far beyond its initial target audience. Conservatives like Riley have expressed concern that the new administration might use pro-grams such as CHIP as a jumping off point for nationalized health care. "Obviously, the governor has concerns about an unbridled expansion of the program," Stacy said in an email. "We never want to begin to lose sight of the purpose, and that is to make sure low-income kids get health care."
The authors of the reauthorization might have acknowledged some of that fear. The re-authorized program eliminates the authority of the secretary of health and human services to grant waivers that allow states to cover parents and childless adults.
Sarah deLone, program director for the National Academy for State Health Policy, said states have found plenty to like about the reauthorization pro-gram and there are many opportunities for them to enhance their programs. "Many states, before the reauthorization, were looking for ways to further expand their coverage, and some even found ways to do it," she said. "But they were hindered from implementing those expansions under the previous administration."
DeLone said in addition to the reauthorization of the program, President Barack Obama's decision to rescind a directive issued by the Centers of Medicare and Medicaid Services in 2007 limiting states' flexibility to set the income eligibility standards for their programs has opened a lot of doors. "Now that those restrictions have been removed, whatever levels states are at now, they have new opportunities," she said. "There is a lot of excitement and interest among the states to take advantage of these opportunities."
Some of those opportunities include the option of covering pregnant women. States have had the flexibility to cover pregnant women, but the reauthorization established a new, explicit statutory option to cover them. Caldwell said that All Kids does not cover pregnant women unless they're already enrolled in the program, but that doesn't mean the state wouldn't explore this option in the future. As it stands now, the only way the program possibly could cover a mother is if she is younger than 19 and already enrolled in the program, she added. [Markeshia Ricks, Montgomery Advertiser, 03/08/09]
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