Let’s be sure children aren’t lost in the healthcare debate

With the Trump Administration in office, talk of changes to healthcare are intensifying. And yet, children’s health coverage has been missing from this conversation. Today, children in the U.S. have nearly universal coverage rates — 95 percent in 2015.

Most of this achievement rests on two major, uniquely child-focused insurance programs that predate the Affordable Care Act (ACA) — Medicaid and the Children’s Health Insurance Program (CHIP) — and is based on a bipartisan belief that children deserve access to high-quality healthcare from birth. It is crucial that healthcare reform not disrupt the essential care these programs provide to our children.

{mosads}Historically, children have had relatively high rates of insurance. I’ve witnessed this throughout my career, from my time as a nurse until today: parents want to protect their children with health insurance. In fact, more than 90 percent of children in the U.S. had health insurance prior to the ACA, either through their parent’s’ employer, Medicaid or CHIP.

Children have been one of the primary groups covered by Medicaid since its establishment by Congress in 1965. Medicaid provides high-quality, affordable coverage to children in low-income families and to children with special healthcare needs. Many may not realize that today, children make up nearly 50 percent of Medicaid enrollees, but less than 20 percent of the costs, making them a very cost-effective group. The vast majority of this coverage is now provided through private companies working for the states, not the government-run programs of yesterday.

CHIP, too, is an extraordinarily cost-effective way to provide for our children’s future. This program, created through a bipartisan consensus in 1997, insures eight million children who fall into the gap of being ineligible for Medicaid, but whose families are unable to afford private insurance. Also now mostly run by private companies working for the state’s, CHIP has already cut children’s uninsurance rates by more than half, and there’s no reason it should stop there.

Today, nearly 50 percent of U.S. children receive care through either Medicaid or CHIP. But, without congressional action early this year, CHIP will cease to exist. And threatened changes to Medicaid would decimate the nearly universal children’s coverage rates we’ve achieved. It is imperative that neither the action nor the inaction of Congress force a decline in children’s health coverage.

As CEO of one of the country’s largest health systems for children and the board chair for the Children’s Hospital Association, I know firsthand how cutbacks to Medicaid and CHIP would dramatically impact our families. For instance, loss of this coverage would result in a return to the days when families would defer preventative care for children with conditions such as asthma or dental caries, leading to sometimes life-threatening, expensive emergencies when children were rushed to the hospital.

There are many misperceptions about the families of children covered by Medicaid and CHIP. Chief among them is that they are from families who are unemployed. To the contrary, 65 percent of children covered by these programs come from employed households.

A new study from PolicyLab, an independent research center at Children’s Hospital of Philadelphia, found that the fastest growing users of Medicaid and CHIP are families in which the parents are insured by their employer, but cannot afford, or were not offered, family coverage.

From 2008 to 2013, the proportion of low-to-moderate-income families electing to cover their children through Medicaid or CHIP increased by 20 percent overall, and by more than 30 percent among families with annual household incomes between $23,500 and $47,000 for a family of four. By 2014, 6.8 million children covered by these programs had parents with health insurance through work.

Alarmingly, the PolicyLab study also detected that some moderate-income families are now not insuring their children at all, due to the cost or the fact that their employer did not offer dependent coverage. This research shines a light on the urgent need to ensure Medicaid and CHIP continue to provide vital, affordable coverage to children in working families.

If we still share the belief that all children should get the care they need to become healthy, productive adults, children’s coverage can no longer be left on the sidelines of this debate, but must instead be at the very center of the conversation. Our future depends on it.

Madeline Bell is the president and chief executive officer of the Children’s Hospital of Philadelphia, and the chair of the Board of Trustees for the Children’s Hospital Association.

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