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Start With The Children

It may have been scary for 13-year-old Job Bedford to testify before the Senate Finance Committee on Capitol Hill, even though his parents, four younger siblings and grandmother were with him. But for Job, who suffers from asthma, the idea of being sick and having no health insurance was even scarier.

Asthma attacks "are very unpredictable" and sometimes so violent that "there's always the thought at the back of your mind that you might just die," the eighth-grader told the senators one day in February. But thanks to the State Children's Health Insurance Program (SCHIP), Job gets the medical care he needs to stay healthy. "There are no words to describe how safe that makes me feel," he said.

Job's father, Craig, a self-employed insurance agent in Baltimore, told the committee how he'd struggled to pay for private health insurance for his family even when the cost ate up 36 percent of their gross income.

"The prospect of our children going without health care insurance was unthinkable," said Job's mother, Kim Lee Bedford. "So we maintained the crippling cost as long as we could." Finally in 2003, desperate when their premiums had reached $800 a month, the Bedfords found they were eligible for SCHIP. Since then, their kids have had full coverage with no copayments—and they can more easily afford insurance for themselves.

SCHIP came into being 10 years ago when Congress voted to give federal funds to states that set up health coverage programs for uninsured children who don't qualify for Medicaid, the federal-state health program for low-income families. SCHIP will expire on Sept. 30 unless Congress reauthorizes it.

"It's been a very successful program," says Jay Berkelhamer, M.D., president of the American Academy of Pediatrics. "It's brought 6 million children into the system who [otherwise] wouldn't have gotten health care." And it's reduced the overall percentage of uninsured children by a third—from over 22 percent in 1997 to below 15 percent by 2005—because SCHIP outreach efforts also identified many children eligible for Medicaid.

SCHIP reauthorization is giving some politicians and analysts the chance to say that health reform should "start with the children" as a doable first step. "Making sure children get affordable care," says John Rother, AARP policy director, "is an essential building block in overhauling our system."

SCHIP will likely be reauthorized, but the issue is the level of federal funding. Holding it to $5 billion a year—the amount set in 1997—would force many children off the rolls, advocates say. They want to at least double that amount to reach another 9 million who are still uninsured.

About seven in 10 uninsured children qualify for SCHIP or Medicaid but aren't enrolled, says Cindy Mann, executive director of Georgetown University's Center for Children and Families and a former federal official who helped set up SCHIP in 1997. Signing them up is key to covering all children, she says. "You can see the end of the tunnel, but without additional SCHIP funding we won't get there."

Another question is who should qualify. The Bush administration wants to limit eligibility to families with incomes under 200 percent of the federal poverty level—now $34,340 a year for a family of three. Among more generous proposals is a bill introduced by Sen. Hillary Clinton (D-N.Y.) and Rep. John Dingell (D-Mich.) that would give extra funds to states that raise the limit to 400 percent, or $70,000 for a family of three.

Under existing rules, 18 states have income cutoffs that exceed 200 percent of the poverty level. The most generous, New Jersey, sets the limit at 350 percent, or $60,000 for a family of three. The state has one of the highest costs of living in the country, says Ann Clemency Kohler, deputy commissioner of the state Department of Human Services. The state covers 127,500 children under SCHIP, with families paying premiums of $36 to $120 a month and copays of $5 to $35 according to income. Another 167,000 children are thought to be eligible but not enrolled, Kohler says.

Some states cover parents as well as children with SCHIP funds, a trend some critics say diverts dollars from kids. But Anne Marie Murphy, director of health care programs in Illinois, says that child enrollment spiked when the state began to include low-income parents—from a yearly enrollment of 216 children in 2001 to 20,525 in 2006.

Last year Illinois began its AllKids program, funded with a mix of Medicaid, SCHIP and state dollars. It now covers 95 percent of eligible children. Murphy says families don't know which program is actually funding them, so the perceived stigma of receiving Medicaid is overcome. "It's doing for children what Medicare did for seniors," she adds. "You can't tell anything about a family's income by the fact they have an AllKids card." For the American Academy of Pediatrics' Berkelhamer, a kind of Medicare program for youngsters—what he'd call MediKids—would "make sure that all children are born into comprehensive medical insurance."

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