As the debate heats up in Washington over the reauthorization of the State Children’s Health Insurance Program (commonly known as S-CHIP), one statistic has been notably missing — according to the Kaiser Family Foundation, as many as three out of four uninsured children are already eligible for state health insurance, but they are just not enrolled.
This little-known fact is crucial to finding some common ground in a polarized debate. If most uninsured kids are in fact already eligible for health care coverage, then actually providing this coverage as part of S-CHIP “expansion” will not bloat the program beyond its original intentions, as some conservatives fear. At the same time, however, if S-CHIP and Medicaid have failed to enroll more than six million eligible kids after 10 years, then simply throwing more money at the existing program, as some liberals have suggested, will have limited benefits. In the end, S-CHIP reauthorization should not be about big government or small government — it should be about good government.
Good government, unfortunately, is awfully hard to find. As a health policy student who has worked to enroll children in S-CHIP, I’ve seen in theory and practice the sly tactics used by states to discourage enrollment. Complicated forms, for example, deter those without a college degree, and face-to-face application interviews remain a barrier for parents who work multiple jobs. Sadly, there is little incentive for change since, in a cruel twist, legislators are actually left with more money in their coffers as more families are discouraged from claiming the benefits that they have been promised.
Recognizing this inherent injustice, a handful of states have been working on reform. In my home state of Pennsylvania, experience suggests that better enrollment policies can work. In 2004, Pennsylvania was one of the few states in the nation to see a decline in the number of kids enrolled in S-CHIP, but last month, after the implementation of a plan to simplify income eligibility and expand coverage to parents, the state reported record-high levels of enrollment for kids.
Unfortunately, a recent federal rule change enacted last month by the Bush administration without public comment may severely limit the ability of states like Connecticut and Pennsylvania to enroll more kids. According to the new rule, if states want to expand coverage to children whose families earn more than 250 percent of the federal poverty level, they will have to show that 95 percent of children under 200 percent of the federal poverty level are covered, a rate that hasn’t been achieved in any state. As a result, thousands of children are expected to lose health care coverage, and the underlying structural problems that prevent eligible kids from enrolling in the program remain unsolved.
Rather than pass stricter government mandates, policy-makers need to change the system to make enrollment easier. One option, called Express Lane Eligibility, proposes coordinating information that is already available through federal programs, such as Food Stamps or WIC, in order to automatically enroll children who are known to be eligible. By cutting unneeded bureaucracy, the government can reduce administrative costs and focus more resources on actually providing health care for children.
This summer, I presented a policy paper in D.C. on behalf of the Roosevelt Institution about an innovative way forward-thinking politicians could take this idea a step further. Tax information from the Earned Income Tax Credit, the federal government’s primary anti-poverty program, could be used to automatically enroll eligible kids. Studies show that almost 90 percent of eligible families with children already file the EITC’s simple form, and since eligibility requirements for the two programs are roughly the same, it makes sense to coordinate them. Families could still enroll in person, and would not be allowed to have both private and public insurance. The only difference would be that working families wouldn’t have to fill out the same information twice and that they could instead take advantage of two great programs at once. For the most technologically advanced country in the world, it is only common sense to coordinate information and get rid of redundant paper forms.
While commonsense reform is always surprisingly difficult to implement, there is a chance that it can be included in Congress’ reauthorization. Both the House and Senate bills include provisions to streamline enrollment and cover the cost of care for eligible children. Under the Senate bill, 85 percent of the additional children who would be covered are already eligible. More needs to be done, but the current bills in Congress are a good start.
As the debate heats up in Congress and as a presidential veto looms, now is the time for us as citizens to insist that good government is good policy for America’s children.
Robert Nelb is a senior in Timothy Dwight College. His column appears on alternate Tuesdays.