The Children's Health Insurance Program

Recently, state health officials were notified of new standards relating to the provision of medical services under the Children’s Health Insurance Program. With a stated goal of “return[ing] the Children’s Health Insurance Program to its original focus on low-income children”, these new guidelines require that, before coverage is extended to children in middle-income families, at least 95% of the children in families who make no more than double the federal poverty level in income must be enrolled. Some states currently have extended coverage under the Program to include families who make as much as three and one-half times the poverty level.

Approximately $30 billion dollars has been asked by the President to be allocated to the program from 2008 to 2012 (an additional $1 billion dollars/year to the $5 billion/year currently allocated). Experts are concerned that this allocation is not sufficient to meet the goals of the 95% enrollment, as they argue that $30 billion is not sufficient to cover the current levels of enrollment. Should the level of enrollment increase, there will be insufficient funds to cover all of the eligible children’s medical costs. However, although the House and Senate have passed bills allocating an average of an additional $10 billion and $7 billion per year, respectively, it has been reported that President Bush has promised to veto these measures as he sees each as “a major step toward nationalized health coverage”.

A recent government study reports that nearly 30% of eligible children have not yet enrolled for coverage under the Program. Aside from the costs of the coverage once these eligible children are enrolled is how to locate such children in the first place. In order to reach the 95% enrollment required to extend coverage to middle income families (from the 72% enrollment rate for 2004-2005), a significant expenditure of funds, of which a large portion of the House and Senate proposed increase would cover, would be required.

The overall goal of ensuring that children in low-income families are provided with health insurance, while not creating a substitute for private health coverage, appears to be a worthwhile initiative. However, without providing sufficient funds, to both locate eligible but non-enrolled children and then to cover their medical costs, it seems that, in reality, sufficient coverage will not be provided by the Program. Also, with such a lofty goal of 95% enrollment, the ability of states to extend coverage to non-insured children from middle-income families will not be possible, presumably leaving a significant number of children in the United States without medical insurance coverage. In order for the Children’s Health Insurance Program to operate effectively in providing insurance coverage to needy children, it would seem that the goals set forth by the government need to be weighed against the funds being allocated, and a proper balance needs to be struck.