States’ budget cuts place poor kids’ health insurance at risk
By LARRY WHEELER and ROBERT BENINCASA
Gannett News Service
WASHINGTON — Children across the country are being cut off from doctors because cash-strapped states are rolling back health insurance for the working poor, a four-month investigation by Gannett News Service has found.
Twenty-two states have restricted children’s health insurance programs over the past 18 months, and more cuts are possible in 2004 as states face another round of daunting budget deficits.
If the trend continues, and many experts believe it will, children, families and communities will suffer serious consequences.
The Gannett News Service investigation found that:
— About 270,000 children of low-income, working parents have been barred from health insurance programs in the nine states where estimates are available.
— Texas and Florida lead the country in the number of low-income children shut out of state health insurance programs.
— Changes to state children’s health insurance programs are expected to hurt immigrant children, especially Hispanics. Hispanic children comprise an estimated 17.7 percent of all U.S. children but represent approximately 37 percent of all uninsured children, according to the Urban Institute.
— For many families, especially those with chronically ill children, the state cutbacks have resulted in immediate hardship.
“We will certainly have sicker kids because of this,” said Leighton Ku, a researcher with the Center on Budget and Policy Priorities in Washington, D.C. “This will cause problems for their parents, too, because if the kids are at home sick, the parents are going to miss work.”
Widespread consequences
Studies show children without health insurance miss more school than their insured classmates and their classroom performance is impaired. That could pose a dilemma for schools across the country that face new federal mandates to improve the performance of all students, regardless of income or ethnicity.
Parents of sick, uninsured children also are likely to seek medical care through hospital emergency rooms and public clinics, even though they can’t pay for it. An increase in so-called uncompensated care will translate into higher prices for families with health insurance, health professionals warn.
“This is a lose-lose for everybody,” said Patti Everitt, of the Texas Children’s Defense Fund. “Families lose, local governments lose and communities lose.”
State health insurance programs for low-income children grew from the innovative State Children’s Health Insurance Program created by the federal government six years ago. S-CHIP was designed to help children whose parents don’t earn enough to purchase health insurance yet aren’t poor enough to qualify for Medicaid.
The program grew rapidly, quickly giving more than 1 million children routine access to doctors, dentists, specialists and prescription drugs — some for the very first time.
But today, a particular child’s access to a doctor depends on where that child lives. That’s because each state has a significant amount of discretion in determining who qualifies for help from S-CHIP.
The result: a patchwork of assistance that has become increasingly vulnerable as each state confronts budget challenges.
Eileen Cooper Reed, director of the Children's Defense Fund in Ohio, says children should not receive health care based on what state they live in. (Glenn Hartong | The Cincinnati Enquirer)
“We’re going to have to figure something out,” said Eileen Cooper Reed, director of the Children’s Defense Fund in Ohio. “We’re the richest country in the world. Children should not receive health care based on what state they live in.”
Children in Virginia are among the lucky ones. After losing tens of thousands of dollars in federal matching funds to other states, Virginia began expanding its children’s health insurance program.
State officials simplified the program’s application process and renewal requirements and began an aggressive campaign to identify and enroll needy children. The state also increased income eligibility to 200 percent of the federal poverty level.
Enrollment climbed from 38,030 in September of 2002 to 52,327 by July of this year, according Virginia records.
“This was morally wrong to leave children without coverage, and it was fiscally wrong,” Democratic Gov. Mark Warner said during a speech last summer to draw attention to the state’s progress.
Children who live in other states face a less optimistic future. In those states, officials have adopted a variety of methods to save money on children’s health insurance.
Texas, for example, which some child advocates say leads the way in cutting health care benefits for low-income children, has adopted restrictions that reduced enrollment by 170,000.
In Florida, 24,000 children are waiting to get into the state’s Healthy Kids program, which has been frozen due to budget cuts. There is no relief in sight.
Nebraska, Minnesota, Maryland and Kentucky saved money by limiting enrollment in their programs.
Nationwide, enrollment for S-CHIP actually increased 7.3 percent to 3.9 million children between June 2002 and June 2003, according to an analysis published in December by the Kaiser Family Foundation.
But that represents the lowest annual growth rate in the program’s history and reflects concerted state efforts to slow the program’s growth, according to the study’s authors.
While enrollment increased in 37 states and the District of Columbia, the number of children in S-CHIP declined in 13 states.
No safety net
Parents are fearful for their children.
“When they drop all this coverage, are these kids just supposed to not have problems?” asked Kathye Smith, 49, of Pasadena, Texas.
In September, Smith lost mental health and dental coverage for her 8-year-old son, Sean, after Texas cut its children’s health insurance program. Sean has attention deficit hyperactivity disorder and was getting help for behavioral problems from a therapist.
Smith is among a growing number of hardworking parents across the nation who had relied on low-cost government health insurance for their children only to have the coverage vanish as states rolled back the programs.
During Thanksgiving week, California’s newly elected governor, Arnold Schwarzenegger, announced he will seek a freeze on the state’s Healthy Families program for low-income children to help cut the state budget by $1.9 billion.
“At the family level, any change that makes it more difficult to get coverage is disturbing,” said Karen Davenport, who manages the Covering Kids and Families campaign for the Robert Wood Johnson Foundation.
“Kids enrolled in Medicaid and S-CHIP get the proper care they need,” Davenport said. “Uninsured kids are more likely to have unmet needs.”
The foundation has spent $135 million since 1997 promoting S-CHIP in all 50 states.
For some families, especially those with chronically ill children, the state cutbacks have meant real hardship.
Catherine Jemski, of Baltimore, thought she could get additional help for her daughter, who suffers from severe seizures, through the state’s Children’s Health Program — until the program began requiring a $40 monthly premium.
“I quit my full-time job last year because her seizures were so unpredictable,” Jemski said. “We can’t afford $40. That’s a lot with only one income.”
Jemski’s husband, Thomas, works full time as a photographer at the University of Maryland School of Medicine in Baltimore. The family has health insurance through the university, but it is not enough to meet the special needs of their daughter Mary, 17, Jemski said.
Hispanics most vulnerable
State cuts in insurance for low-income Americans have hit Hispanic families particularly hard.
“For immigrant kids, many of whom are heavily concentrated in a handful of states and major cities, those areas are going to disproportionately feel the burden,” said Randy Capps, an Urban Institute researcher.
“Where are they going to go for health care and where is the funding going to come from to provide the extra care when they show up at hospital emergency rooms or public health clinics?” Capps asked.
Blanca Moreno, a Hispanic mother in Omaha, Neb., has good reasons to ask those questions herself. In September, her two boys — Ladislao, 4, and Cristian, 16 months — suddenly became ineligible for health insurance through Nebraska’s Kids Connection.
“Both children had had insurance since the day they were born,” said Moreno, 23.
Ladislao and Cristian were deemed ineligible because the family’s income exceeded new state guidelines, said Moreno, a stay-at-home mom.
Her husband, also named Ladislao, earns $1,450 in a good week as a construction worker. But some weeks he earns nothing because of bad weather or a general slowdown in new building. And he does not have health insurance through his employer.
“It’s almost as if our children would be better off if my husband didn’t work, but then we wouldn’t get to eat or pay the rent,” said Moreno.
(Contributing: GNS reporter Sergio Bustos)