Two years after Congress passed a law designed to get millions of uninsured children covered, a consumer watchdog report released Wednesday shows that in 12 key states, the number of youngsters with health insurance has actually declined.
It's true that enrollment in the Child Health Insurance Program (CHIP) a 10-year, $60 billion federal-state program, has increased by more than 55 percent in the 12 states studied by Families USA, a group that advocates affordable health care. These 12 states have the largest number of uninsured children (together they account for 4.9 million of the 7.5 million uninsured children in the U.S. as of June 1999).
But at the same time, the number of children enrolled in Medicaid in those states has declined so much as to wipe out the gains made by the new federal program. "We're no further down the road toward protecting children than we were in 1996 or '97,'' said Ronald Pollack, president of Families USA at a news conference.
"We are taking an impressive step forward in covering children through the Children's Health Insurance Program. But due to the state's shoddy implementation of welfare reform, we are taking an even larger step backwards in covering kids."
The bottom line: The number of children covered by the new federal program in the 12 studied states increased from 593,868 to 920,796 in 1999. Medicaid enrollment in those same states during the same time decreased from 11.2 million to 11 million. That means 219,901 fewer children are enrolled in these health insurance programs.
The 12 states with the largest number of uninsured children are: Arizona, California, Florida, Georgia, Illinois, Louisiana, New Jersey, New York, North Carolina, Ohio, Pennsylvania and Texas.
The starkest example of coverage declines is in Texas, where between 1996 and June of this year, 193,400 fewer children had health insurance -- a decline of 14.2 percent. In 1996, there were 1.36 million Texas children enrolled in Medicaid. By June 1999, with the implementation of welfare reform, the Medicaid enrollment had dropped to 1.13 million. But only 34,553 children have been enrolled in the new federal program, leaving nearly 200,000 children who were once covered without health insurance.
In addition, Pollack said, studies by the Urban Institute and other think tanks have shown that even for those leaving welfare and going into the work force, the jobs they were able to get were at the lowest rung of the economic ladders. And more than three-fourths of those jobs have not included health insurance benefits.
According to the latest U.S. census report, between 1996 and 1998 the number of uninsured children grew nationwide from 10.6 million to 11.1 million. "We've started making an aggressive effort to remind people that just because we're encouraging them to find jobs that they still qualify for Medicaid and food stamps,'' said Michael Jones of the Texas Department of Human Services. "Those are the kind of services to help people until their income rises high enough or they go far enough in the work force that they no longer need those services.''
Jones said because the Texas legislature meets every two years, it has been slower than other states to fully implement the CHIP program but expects the program to be fully running by next spring.
With $60 billion available in state and federal funds, said Sen. Edward P. Kennedy, D-Mass, "we ought to be able to have every child in this country have their health care covered." Kennedy has crusaded for universal health coverage for decades and is the co-author of the CHIP legislation. "As this report clearly shows, both the states and the federal government have work to do to see that this health coverage is available in practice," Kennedy said.
Not all the news in the report was bad. North Carolina had a 15.8 percent increase in the number of children with insurance coverage and Louisiana had an 8.4 percent increase.
There are several explanations for the uninsured statistics. Until the 1996 welfare reform, most poor Americans were enrolled in the welfare and Medicaid programs simultaneously. So when people were taken off the welfare rolls in an effort to get them working, children began to lose Medicaid health coverage.
The Families USA report says that children lost coverage either because family earnings exceeded the Medicaid eligibility levels or because Medicaid was cut off at the same time their families were dropped from the welfare rolls.
And a third way was more subtle. As states began to deter families from applying for welfare and instead steered them to job training and other welfare-to-work type programs, people were also deterred from applying for Medicaid, even if they were still entitled to be part of that health insurance program, Pollack said.
Pollack and Kennedy did not fault either the amount of money invested in CHIP or the federal government's promotion of the program for the lackluster results. What's needed, Pollack said, is for the states to make sure that children wrongfully dropped from Medicaid get their benefits restored, that it's easy for people to apply for both Medicaid and CHIP and that welfare recipients moving to work are still encouraged to apply for Medicaid so children won't continue to go uninsured.