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Child Watch® Column: "This Is Congress's Chance to Fix the Health Care System for All Children"

Release Date: June 26, 2009

Marian Wright Edelman

On June 23, I testified before the House of Representatives Committee on Energy and Commerce, Subcommittee on Health, to comment on its comprehensive health reform discussion draft. I pressed the Subcommittee on the need for health care reforms that extend affordable and accessible coverage with comprehensive benefits to all children in every state and urged them to simplify enrollment and retention, particularly in Medicaid and the Children's Health Insurance Program (CHIP). I applauded a number of the proposals in the discussion draft, like the strong public health insurance option that will force insurance companies to compete and help control costs for consumers and the elimination of pre-existing conditions as a basis for denying health coverage.

But my chief concern about the House proposal is its failure to ensure that children will be better off than they are now and that some children are at risk of being worse off. And Congress needs to be especially sensitive to the huge health and wealth disparities among children in communities of color who represent almost two-thirds of all uninsured children.

Earlier this year, Congress passed CHIP Reauthorization legislation to extend health coverage to four million uninsured children—but that was not the real health reform for children. It did not establish a national eligibility floor for all children or give lower income children enrolled in CHIP the same comprehensive benefits to which children in Medicaid are entitled. Now is the time to finish the job and ensure all children a strong and equitable national health safety net.

Ensuring that children get health coverage early to prevent or treat childhood illnesses that could affect them in adulthood is one of the best ways to bend the long-term cost curve. Covering children is not expensive, and yet nine million children in America remain uninsured. To ensure all children get the health coverage they need, I hope you will join me in urging Congress to include the following three assurances for children in any health reform package they pass this year:

Health coverage must be affordable. The House discussion draft calls for expanding the Medicaid eligibility floor to 133 percent of the Federal Poverty Level (FPL). This would theoretically expand health coverage to 36 percent of poor uninsured adults and 3.7 million uninsured children if all were able to enroll. Not a single new child would be eligible under the House bill as all states already cover children of all ages at or above 133 percent FPL. These children are already eligible but are uninsured because of state bureaucratic barriers. A national eligibility standard must go higher in order to ensure that all children and pregnant women have access to affordable health coverage. The Children's Defense Fund proposes establishing a national income eligibility floor of 300 percent of the federal poverty level—$66,150 for a family of four. The Senate Finance Committee option paper comes close with a proposal to go to 275 percent FPL ($60, 638 for a family of four) but .

Today, each state sets its own income eligibility levels for CHIP and Medicaid within broad federal guidelines. This has resulted in a profoundly inequitable patchwork of eligibility across the United States. Congress has the opportunity to eliminate the unjust lottery of geography that leaves one-third of our nation's children enrolled in 50 different state systems, each with different rules about eligibility, enrollment and recertification.

All children and pregnant women must have comprehensive health and mental health coverage. All children and pregnant women need a benefit package that is designed to support their optimal development. This benefits standard should apply to all child health plans—Medicaid and CHIP, those offered by employers as well as those incorporated in the Exchange. Currently, children enrolled in Medicaid are entitled to the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefit package, which recognizes the importance for children of all ages to get regular and periodic screenings and assessments at various intervals throughout their lives. This is one best standard for age-appropriate child health coverage. We hope Congress will extend it to all children in CHIP and all children in America.

All eligible children should get and stay enrolled in health coverage. The numerous barriers imposed by states that prevent children from enrolling in Medicaid and CHIP often lead to unnecessary, costly and dangerous coverage gaps.

I urged the Subcommittee to institute a system of streamlined enrollment for children that will identify and enroll all children. The discussion draft includes a good provision to enroll all uninsured children at birth, but there should be automatic enrollment of children at other critical junctures when they enter Head Start or preschool, school, or participate in any means tested program like WIC or school lunch. Many other barriers such as face to face interviews and less than 12 months continuous eligibility should be prohibited.

All of us at the Children's Defense Fund will be working tirelessly as the legislative process moves forward and Congress debates various health care proposals to ensure that children are not thrown overboard. The stakes are high because the broken child health and mental health system is a major feeder system into the Cradle to Prison Pipeline for hundreds of thousands of minority children each year. Now is the time to fix it. Children have only one childhood. It is morally and practically indefensible in 2009 in the wealthiest country in the world with a $14 trillion economy for our leaders to be debating how many or few children we can afford to provide health coverage. We don't have a money problem.We have a profound values and priorities problem. If Congress can find the money to bail out banks, insurance and auto companies, it can find the money to bail our babies and children out of preventable sickness and disease. But they won't do it unless you stand and speak up for our children.

The test of the morality and common sense of a society is how it treats its children who are the human capital upon which our collective future depends. Can our children count on you to call your Senators and Congressmen and tell them to extend health coverage to all children now? If you don't do so, who will?


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