As the debate over healthcare reform rages on in the United States, children's advocates are busy analyzing on how two healthcare bills in the House and in the Senate Finance Committee will affect children of low-income families when a national insurance program expires in 2013.
While no legislation has sought to extend the expiration date, the question is what will happen afterwards, said Rachel Klein, deputy director
of Health for Families USA, a healthcare consumer policy and advocacy group.
The Children's Health Insurance Program (CHIP) targets the 6 million low-income uninsured children who do not qualify for Medicaid, a program that covers 28 million American children.
But under the House bill, CHIP will be terminated on Oct. 1, 2013. At the bottom end, CHIP children below 150 percent of the federal poverty line (FPL) will be moved to Medicaid. Those above will be covered by employer-based insurance or through the market exchange, also known as the "public option."
Under the Senate Finance bill, CHIP will be offered until 2019 and the program must be reauthorized and funded before Sept. 30, 2013. Children below 133 percent of the FPL will be moved to Medicaid.
"There are pros and cons to both approaches," Klein said in a recent telephone interview with Xinhua.
There are several reasons to phase out CHIP.
Unlike Medicaid, it is a capped block grant and is subject to cuts when federal or state funding falls short. Medicaid also provides coverage for all of those who are eligible without any waiting lists or limits on enrollment.
In addition, even if the Senate bill is passed, CHIP's future is uncertain. When U.S. President Barack Obama reauthorized CHIP in February this year, the national debate was highly contentious. Various policymakers called for limits and restrictions, which is bound to occur again. With a worsening federal budget, it might be harder to secure substantial new CHIP funding without scaling back eligibility limits or benefits.
On the other hand, CHIP advocates point to recent studies that suggest CHIP is at an all-time high, having grown 15 percent over the past year
alone.
Consensus data and a report by the Center for Children and Families (CCF) at Georgetown University's Health Policy Institute show that more than 20 states have expanded or improved children's health coverage since February.
In the end though, whichever bill is passed, Klein said, healthcare reform is a welcome move.
Both bills will expand Medicaid for adults by providing financial assistance in the form of premium subsidies to low- and moderate-income
individuals and families with income up to 400 percent of the FPL.
"This would be the first time that we would be providing subsidies to help families afford health coverage if they don't qualify for CHIP or
Medicaid," said Klein.
Both bills also seek to streamline the Medicaid enrollment process, making it easier for parents to sign up with their children.
"What we've learned from research is that making parents eligible too helps with efforts to get the uninsured kids enrolled because these programs are complicated," said Klein. "It makes it just that much more complicated to tell families about the program and how to enroll and what to do."
Getting children enrolled in healthcare is paramount. Uninsured children are 60 percent more likely to die after being admitted to the
hospital than children with health insurance, according to a study of hospital records by Johns Hopkins' Children's Center.
Providing quality and affordable healthcare to children is the safest bet to mitigating long-term problems, according to Gail Wilensky, a senior fellow at Project HOPE, an international healthcare advocacy group based in Virginia.
"Many of the biggest challenges the country now faces begin in childhood," Wilensky, a former commissioner on the World Health Organization
Commission on the Social Determinants of Health, said in an opinion piece published this week.
"Obesity, cardiovascular disease, cancer and mental health problems -- conditions that account for more than 75 percent of health-care spending
today -- all can have roots in the early years of life," she said.
Even before birth, society has an opportunity to cut future costs and ensure a child's future well-being, said Dr. Nereida Correa, who is medical director of the MIC Women's Health Services of the Medical and Health Research Association of New York and is in charge of prenatal care.
Providing prenatal care to mothers and their unborn children is the first chance at preventing complications down the road.
"We have good data to show that if you put in a program where the woman has early prenatal care, you can control diabetes and detect problems such
as high blood pressure," she told Xinhua.
This means making sure that pregnant women have access to nutritional food, vitamins and that they stay away from substance abuse, she said.
As policymakers debate healthcare reform, children's advocates agree that denying health coverage that is easily accessible and affordable
saddles a beleaguered system with a large financial burden and deprives children of the chance to grow up in a healthy and happy way.