1. North Carolina: Insuring More of Our Children A year ago, a newly elected President Barack Obama signed the reauthorization of the Children's Health Insurance Program into law, extending and offering needed funding to the popular, successful public health insurance program for children in low-income families. The reauthorization allowed North Carolina's CHIP, called Health Choice, to increase enrollment by about 9,000 children this year--children who otherwise would have been uninsured. Thanks to broad support across the state, Health Choice has been a huge win for North Carolina. Health Choice helps more than 100,000 children in working families all over the state who would otherwise be uninsured get the checkups they need to stay healthy and to see doctors when they get sick. North Carolina's health dollars are spent wisely with Health Choice, providing coverage so a boy with asthma can get a $40 inhaler rather than allowing his condition to go untreated and spending thousands of dollars on an emergency room admission for a full-blown asthma attack. Covering children is good for our economy--helping parents to stay on the job, rather than miss work to take a sick child to the emergency room, and reducing long-term medical costs. But 264,000 of North Carolina's children are still uninsured. That's enough to reach from Greensboro to Wilmington, holding hands. Many of these children are eligible for Medicaid or Health Choice but are not enrolled, either because they have not been reached or because of limited funding (Health Choice is first come-first served and has an enrollment cap). The rest are children who live in families that make more than the cutoff for Health Choice (about $44,000 for a family of four) but not enough to buy health insurance on the open market. North Carolina is losing employer-sponsored health insurance faster than any other state in the nation, and many of these children's families have lost their work-based insurance plans. A plan to cover more children (in families making up to $66,000 for a family of four) passed the state legislature in 2007 but has yet to be implemented because of the recession. The plan, called N.C. Kids' Care, would extend quality coverage to thousands of children who are uninsured. As our federal leaders work toward national health reform, we need to remember children's needs, and we need to remember what works. Health Choice and Medicaid are successful, proven programs that ensure that thousands of children in our state receive the medical care they need. These public health insurance programs are cost-effective and work for our state. They should be expanded to cover more children in need. North Carolina's eventual goal should be to cover all children with comprehensive health insurance, be it private or public. As New York Times columnist Nicholas Kristof wrote recently, why is it that universal coverage for the elderly is broadly accepted (Medicare), while it's controversial to ask the same for children? Covering children is cheap (because they are relatively healthy) but essential. Just consider: A recent Johns Hopkins University study found that hospitalized children who are uninsured are 60 percent more likely to die than those with insurance. [Mandy Ableidinger 02/19/10] 2. National: White House Hopes to Expand CHIP Through 2016 The health reform blueprint unveiled by President Obama earlier this week is being described everywhere as an amalgamation of the Senate and House bills. When it comes to children's coverage, though, that's not quite the case. While the House has proposed to scrap the popular Children's Health Insurance Program in 2014, and the Senate offered two addition years of CHIP funding (through 2015), the White House goes a step further, proposing a funded CHIP extension through 2016. The move drew quick praise from a number of children's welfare advocates, who have warned for months that the House proposal to shift kids from CHIP into private exchange programs would hike costs on low-income families, thereby discouraging parents from buying coverage for their kids at all. The Congressional Budget Office backed that claim, arguing that, as a result of that shift, "Some of those children would be eligible for subsidized coverage in the exchanges but would not be enrolled in an exchange plan." Bruce Lesley, president of First Focus, a kids advocacy group, said he's heartened by the White House proposal. "After months of policy disputes over kids and health reform, we are pleased that President Obama has sided with children's advocates, experts, actuaries, and the public on what is best for America's children--the preservation of the highly successful Children's Health Insurance Program." Whether that proposal stands in the final bill has yet to be seen. [Mike Lillis, Washington Independent, 2/24/10] 3. National: Note to Congress--Don't Forget the Kids Just over one year ago, members of Congress were patting themselves on the back for the reauthorization of the Children's Health Insurance Program (CHIP) through 2013. Now, no one is sure what to do with it. The popular and successful program might be used as a bargaining chip for more comprehensive health care reform. Under the House reform proposal, CHIP would be scrapped completely at the end of fiscal 2013 with kids' coverage being shuffled into either expanded Medicaid coverage or insurance exchanges along with their parents. The Senate proposal offers an additional two years beyond 2013, while President Obama's most recent compromise holds firm for full program funding through 2016. While CHIP supporters acknowledge that the continuous renewal of the program's funding would subject it to the political whims of the day, research has shown that children and their families are much better off under the federally funded plan. A study last year by Watson Wyatt Worldwide, an actuarial research firm, found that families living between 175 and 225 percent of the federal poverty level pay less than two percent of medical bills under CHIP. If forced to use private exchanges, those same families would pay up to 35 percent of their children's health costs. The Congressional Budget Office also agreed with this analysis, stating that the higher costs of exchanges may leave children uncovered. "For any who had doubts, this study confirms that children currently enrolled in the Children's Health Insurance Program have the best, most affordable care," said Bruce Lesley, President of First Focus, who commissioned the study. While the 2009 CHIP reauthorization has resulted in the addition of 2.6 million children to the program, there are still an estimated seven million who are uninsured with almost five million of those eligible to join either Medicaid or CHIP. Health and Human Services Secretary Kathleen Sebelius launched a campaign in February, known as Connecting Kids to Coverage, to find and enroll these children. In addition, to make sure the care provided is meeting quality standards, Sebelius announced last week the award of $100 million of grants to ten states. The money will help states implement and evaluate provider performance measures and utilize health information technologies such as pediatric electronic health records and other quality improvement initiatives. The funds were included in the reauthorization act. "These awards will help create the foundation for a more responsive and effective national system of high quality health care for children," said Cindy Mann, director of the Center for Medicaid and State Operations within CMS. And that is the bottom line: continued, affordable, quality coverage for those patients who are the most vulnerable. We should not settle for anything less. [Dan Peterson, healthcare.change.org, 03/03/10]