Abstract
Access to quality health insurance is a problem for many people, but especially for children. One of the main goals of recent U.S. health insurance policies is to increase health insurance access for children. The driving force behind Children Health Insurance Programs (CHIP) is the recognition that investing in children’s health is important to their education and ability to contribute to society in the future. A cumulated review of research examining the impact of CHIP on children’s health is positive and suggests that CHIP programs are advancing the goal of health coverage which is better health. Although the source of funding for CHIP is often controversial, CHIP provides effective health care coverage to needy children and ensures children get the needed health service necessary for them to succeed in life.
Effective, Affordable Health Insurance for Needy Children: CHIP
Children need health insurance. Access to quality health insurance is a problem for many people, but especially for children. One of the main goals of recent U.S. health insurance policies is to increase health insurance access for children. The driving force behind Children Health Insurance Programs (CHIP) is the recognition that investing in children’s health is important to their education and ability to contribute to society in the future. Joycelyn Elders, a former U.S surgeon general, said, “You cannot educate a child who is not healthy, and you cannot keep a child healthy who is not educated” (Oral Health and Learning 3). The availability of health insurance for children will increase their utilization of medical care and hence improved overall health. Even though Medicaid was expanding during the 1980s, millions of children remained uninsured (The Children Health Insurance). Something needed to be done to address the gaps in coverage between the poorest populations where children received Medicaid and the more affluent populations where children and their families could not afford health insurance. With bi-partisan leadership, the federal government established the Children’s Health Insurance Program (CHIP) in 1997 as a federal and state partnership. States administer the program with the expressed purpose of providing health insurance for children who do not qualify for Medicaid nor have access to other forms of insurance (The Children Health Insurance Program). State’s Children Health Insurance Program (SCHIP) gives families who earn too much to qualify for Medicaid but earn too little to be able to afford private insurance, a means of covering their children (“CHIP in Texas”). Families USA, the voice for health care consumers, claims that “lawmakers from both parties have recognized that investing in children’s health is an investment in the country’s future” (Mahan). Although the source of funding for CHIP is often controversial, CHIP provides effective health care coverage to needy children and ensures children get the needed health service necessary for them to succeed in life.
Even though CHIP is a state-federal partnership, states have flexibility in designing their program and determining how to spend the federal dollars received for the health insurance program for these uninsured children (Medicaid.gov). A state must follow some federal guidelines, but overall, states have more flexibility in their administration of CHIP than they have with Medicaid. Some states have separate CHIP programs, and some states include CHIP as part of their Medicaid expansion. Of the children enrolled in CHIP, roughly 44 percent are involved in separate CHIP programs, and the other 56 percent are part of a CHIP Medicaid expansion program. (Mahan). Combined, CHIP and Medicaid provide insurance coverage to approximately 39 percent of all children in the United States (Mahan).
CHIP is available to children under 19 years of age (Mahan). Those who apply for CHIP are required to be a U.S. citizen or legal permanent resident. In the state of Texas, CHIP can be offered to children up to 20 years old under certain conditions (“CHIP In Texas”). The enrollment in CHIP is open to any pregnant women, regardless of age, so that they can receive coverage for their unborn child (CHIP In Texas). Families USA mentions four categories of children who benefit from CHIP: children with special health care needs, children in working families, children of color, and children in rural communities (Mahan). According to Texas Health and Human Services, more than 4 million low-income Texans are covered by Medicaid and CHIP (“About Medicaid and CHIP”).
Families qualify for CHIP based on their annual income and size of their household. According to the Kaiser Family Foundation, “the median income eligibility threshold for CHIP is 255 percent of poverty level which is $60,818 for a family of four” (Vestal). In Texas, CHIP applicants in a “household of four must not exceed an annual income of $49,086 in order to qualify for benefits; a five-person household cannot surpass an annual income of $57,449 to be eligible” (“CHIP in Texas”). There is a small cost the families must pay towards their enrollment in CHIP. In Texas, it costs the family $50 or less per child per year depending on the size of the household (“CHIP in Texas”). Medicaid is different because there is no cost, and there are no fees for co-pays. CHIP is affordability to low income families reduces the uninsured rate among children. “Nearly 90 percent of children covered are in families earning 200 percent of poverty or less” (Mahan).
Paradise found that in 2011, 87 percent of children who were eligible for Medicaid and CHIP participated in these programs nationwide, although the rate did vary by state and by subgroups of children. It is noteworthy to mention that between 1997 and 2012 “the uninsured rate for children fell by half, from 14% to 7%” (Paradise), signaling that the program is working. CHIP and Medicaid play an especially large role in this drop in uninsured children, especially for specific populations of children, those of color and those with special health care needs. According to Julia Paradise’s research on the impact of CHIP, “CHIP and Medicaid cover more than half of Hispanic children (52%) and Black children (56%), compared to one-quarter of Whites (26%) and Asian (25%) children” (Paradise, 2014). Children with special health care needs are the most likely group to be eligible for CHIP and Medicaid programs. According to a research study conducted by Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation, Chip covered 8.1 million children at a total cost of more than $13 billion in 2013, and the program has been instrumental in reducing the number of uninsured children “nationally from 10.7 million in 1997 to 6.6 million in 2013” (The Children Health Insurance 1).
Paradise’s research concluded that “Medicaid and CHIP have significantly expanded health coverage among the U.S. children and provided a coverage safety-net for children in working families during economic downturns. The programs now cover more than one-third of all children (37%) in the U.S.” (Paradise). A more recent 2017 study by Families USA concludes that “together CHIP and Medicaid cover 39 percent of children in the United States. Today CHIP covers nearly 9 million children” (Mahan). These research studies suggest that the trend of uninsured children is decreasing because of CHIP, and CHIP has helped reduce disproportions in coverage for low-income children and children of color.
Ensuring that all children have access to affordable, comprehensive, high-quality health coverage is where most citizens and congressional leaders agree. CHIP participants “have much better access to primary and preventive care and fewer unmet health needs than uninsured children. Medicaid and CHIP programs have indeed expanded the health benefits for children. In some cases, CHIP even provides better services than private insurance when it comes to children’s health and development needs, such as speech therapy and dental health (Mahan). However, benefits do vary because of the flexibility states have in designing their CHIP programs. Federal guidelines mandate that all CHIP programs cover speech and language therapies, hearing test and hearing aids, pediatric benefits, and dental care (The Children’s Health Insurance Program; CHIP In Texas). States that do not have CHIP as part of a Medicaid expansion afford the state greater openings to adapt their CHIP program according to what they see as the children’s greatest needs. Paradise’s research found that all separate CHIP programs cover outpatient and inpatient mental health services, without limits, as well as substance abuse treatment, annual eye exams and coverage for glasses (Paradise). According to Texas-benefits.org, Texas Children’s Health Insurance Program “covers visits to doctors, necessary vaccines, any needed prescriptions, lab tests and x-rays (“CHIP in Texas”). Texas CHIP also includes any needed hospital care for qualified children” (“CHIP in Texas”.).
Dental coverage is another huge benefit for children. Dental disease is the most common childhood disease (Oral Health and Learning). Julia Paradise mentioned that “untreated dental problems cause pain, school absence, and missed work among parents” (Paradise, 2014). Oral disease decreases a child’s appetite and hinders their ability to pay attention in the classroom, which leads to school failure (Oral Health and Learning). Research presented by the US General Accounting Office’s publication, Oral Health: Dental Disease Is a Chronic Problem Among Low Income and Vulnerable Populations, concluded that “poor oral health can lead to decreased school performance, poor social relationships, and less success later in life. Children experiencing oral pain are distracted and unable to concentrate on schoolwork” (Ora; Health and Learning 1). David Keller, et al., concluded that children under CHIP or Medicaid are more likely to get preventive medical and dental care than privately insured children (Keller, et al).
It is apparent by the body of research done on CHIP that children who have CHIP are taking advantage of the program and more likely to seek preventative care (Lurie 1518). Ithai Zvi Lurie concludes her article, Differental Effects of the State Children’s Health Insurance Program Expansions by Children’s Age, with the findings that physician visits did increase under CHIP, especially for post-elementary age children (Lurie, 2009). Routine physician visits by older children allow doctors the chance to educate these teens on risky behavior, proper diet, exercise, and birth control. It is also significant that children under CHIP are less likely to experience unmet medical needs. Paradise states that “in nine of ten studies cited in the Congressionally-mandated evaluation of CHIP, rates of unmet need were reduced by 50% or more” (Paradise), and Families USA makes similar claims (Mahan). However, statistical evidence regarding the actual impact of CHIP on the overall health of children is mixed. Julie Paradise’s research on Medicaid and CHIP completed in 2014 found that some studies show “a positive impact on health outcomes, including reductions in avoidable hospitalization and child mortality, while others show no impact on health” (Paradise). For example, one “national study found that a 10-percentage point increase in Medicaid/CHIP eligibility (e.g., from 30% of children in a state in a particular age group to 40%) resulted in a roughly 3% decline in child mortality” (Paradise). Paradise concludes that most low-income parents enrolled in Medicaid and CHIP appreciate the program and express a high degree of satisfaction with “the quality of care, the range of covered services, and affordability” (Paradise).
Since more children have their health care needs met under CHIP, it stands to reason that these children will have an increased chance of achieving greater success in school. Julia Paradise’s review of the research leads her to conclude that “there is evidence that improved health among Children with CHIP translates into educational gains with potentially positive implications for both individual economic well-being and overall economic productivity” (Paradise, 2014). Families USA also advocates that “children’s health, school performance, and future success in life are all linked” (Mahan). A study by Steven Shaw, et al. compared healthy children to unhealthy children. One of their conclusions was “unhealthy children are at higher risk for school problems, failing, or dropping out” (Steven, et al.). Common sense would suggest that since healthy children are more likely to attend school, and since attending school provides children with more opportunities to learn the material, healthy children are more likely to succeed in school. Success in school contributes to the child’s ability to become a productive adult. Few would debate the significant correlation between a child’s school performance and future success. Carolyn Schwarz and Earl Lui reviewed published articles which looked at the link between health insurance and school performance (Schwarz and Lui). They were led to draw the conclusions that “good health is connected with improved school performance and having health insurance is linked to better health” (Schwarz and Lui 1). The rational deduction to be made would be that children who are insured experience good health, and healthy children have a greater chance to succeed in school.
CHIP does, in fact, provide effective health care coverage to needy children and ensures that children get the needed health service necessary for them to succeed in life. A cumulated review of research examining the impact of CHIP on children’s health is positive and suggests that CHIP programs are advancing the goal of health coverage, that is better health. Kenney and Chang state it best: “By many different measure, SCHIP has been a success. It has provided health insurance coverage to millions of children and improved their access to care” (Kenney and Chang, 2014, p. 59). Unfortunately, uninsured children remain, and many of these children are eligible for CHIP. Better education of parents might be needed so these children can get the insurance services available through CHIP, and thus allow these children to receive the health care they need. Of course, financing for CHIP will always be an issue. States are likely to face funding issues as the federal government deals with their own large federal deficit, and congressmen must determine what federal money will support which programs.
Work Cited
“About Medicaid and CHIP.” Spoink. August 26, 2016. Accessed March 23, 2018, hhs.texas.gov/services/health/medicaid-chip/about-medicaid-chip.
“CHIP In Texas.” CHIP In Texas | Texas-Benefits.org. Accessed March 23, 2018, texas-benefits.org/Medicaid/Medicaid-CHIP.html.
David Keller, et al., “Kids with Medicaid, CHIP get more preventive care than those with private insurance,” JAMA Pediatrics, November 16, 2015,media.jamanetwork.com/news-item/kids-with-medicaid-chip-get-more-preventive-care-than-those-with-private-insurance/.
Kenney, G., and D. I. Chang. “The State Children’s Health Insurance Program: Successes, Shortcomings, And Challenges.” Health Affairs, vol. 23, no. 5, Jan. 2004, pp. 51–62., doi:10.1377/hlthaff.23.5.51.
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