Children`s Health Insurance Program (CHIP) – is it a successful health coverage program to uninsured children?
In America, the number of uninsured children is about 7.6 million. This represents one child in every ten children is uninsured. Statistics reveal that in every 67 seconds, a child who does not have insurance is born, thus translating to over 1290 cases on the daily basis (Institute of Medicine et al, 1998). The CDF has been working towards enhancing the health of children. Apparently, it has passed legislation to ensure access to affordable and comprehensive health coverage for children (United States Congress Senate Committee on Finance, 2007). This was the 2010 Health Reform Bill that offered access to health coverage for over 95% of the total children. Unluckily, eligibility for coverage in most states does not translate to enrolment in coverage. Around half of the uninsured children qualify to be enrolled for the Children`s Health Insurance Program (CHIP). However, those children are not enrolled due to bureaucratic barriers. Having the qualified children enrolled for CHIP is quite a challenge. Nonetheless, CDF continues to fight to ensure all children get a healthy start required to thrive and survive in life.
Children`s Health Insurance Program (CHIP) can be defined as a program governed by the Department of Health and Human Services in the United States that avails funds to its states for children`s health insurance to families. The main reason for designing this program is to provide insurance to the children in families earning modest incomes that are too high to be eligible for Medicaid (Zuckerman & Cook, 2006).
Children`s Health Insurance Program was created in 1997. At its formation, it was the greatest development of health insurance coverage for young ones funded by taxpayers in the United States. CHIP is under a statutory authority titled XXI of the Social Security Act (Broaddus & Park, 2006). The program was sponsored by Senator Orrin Hatch and Senator Edward Kennedy with the support of First Lady Hillary Rodham Clinton over the reign of Clinton (Broaddus & Park, 2006).
Apparently, states have the freedom to design their Children`s Health Insurance Program eligibility policies and requirements within extensive national guidelines (Woolridge et al, 2005). Some states get authority through waivers of statutory provisions to use the program`s fund to cater for parents of children covered by CHIP as well as older people. Statistics indicate that in 2006, CHIP covered around 670,000 adults, and 6.6 million children. Irrespective of the implementation of the Children`s Health Insurance Program, the number of uninsured children continued to heighten especially for the families that cannot qualify for the program. It is clear that, 68.7% of the uninsured children came from families that were below the national poverty line. This resulted as majority of the employers had dropped either dependents or coverage because of the yearly premiums that were seen to double between the years 2000 and 2006.
Health coverage for children is an important determinant for health care access. Health affects the life of a child in every aspect, including their ability to grow, play, learn and thrive in life. A child is able to maintain good health if he/she has a healthy relationship with the health giver during health and sickness. Besides about 8 million uninsured children in the U.S., there are millions more who are underinsured. As a result, a lot of children do not get access to comprehensive health care. In addition, most of them forgo preventive healthcare due to high costs and other barriers (U.S. Department of Health and Human Services, 2009). Evident from statistics:
* The number of children not insured has a high probability than insured children to post pone or delay their treatment of diseases such as diabetes, asthma or obesity. Additionally, they have a high probability as compared to the insured children to visit a doctor for medical checkups. Studies indicate that regular health checkups are of paramount to the health of a child. This is because they help the doctors to determine and treat health problems in a timely manner, and this contributes to the healthy development of a child. Projected two-thirds of youth and children suffering from mental health are not getting the health care they need.
* The uninsured children have a probability of over four times as the insured children to have unattended dental health needs. It is clear that children missed school with over 51 million hours in 2001 as a result of dental-related illness.
* The insured children perform far much better than uninsured children in school. This means that having children enroll in health coverage results to improved school performance.
* The minority children are the most affected by uninsured. Approximately, 1 out of 10 children in the white community are not insured. The same goes for every 1 out of 9 for the black children and 1 out of 6 for Latino children
Achievements and Challenges
A number of evaluations have been carried out to determine the success of Children`s Health Insurance Program. It is clear that, the program is successful in all areas where evaluation is being carried out (Smith, 2011). Since the program was established, it has increased the children`s enrollment to 6.1 million in the fiscal year 2005. Resultantly, the proportion of the uninsured children dropped to 14.9 percent from 22.3 percent between 1997 and 2005. Though there was improved coverage, around 9 million children below 19 years had not been insured by 2005. The major reasons that made them not to enroll were reported to be misunderstandings regarding eligibility and enrollment barriers. The children who had enrolled to the Children`s Health Insurance Program reported reduced unattended health care needs. As noted by Henderson & Steinberg (1999), the children who gained coverage via the program received better preventive health care as compared to those who did not.
Additionally, the parents of these children reported a comprehensive access and communications with healthcare providers. Ross & Cox (2005) indicates that, the uninsured children who were gaining coverage through the CHIP program had reduced health care attacks after enrollment and improved quality health care. The program`s funding structure is successful and flawed at the same time. It has been successful in attaining its aim of fostering state expansions while limiting national liability with a similar rate to adequately enhance states to extend health coverage. Nonetheless, CHIP`s success in enrollment for children has come up against its national funding limits.
The stated goal of the Children`s Health Insurance Program is to avail health care assistance to the children who were uninsured and low income children effectively and efficiently. The basis of qualification is on a mix of state flexibility and national targets. The statute authorized national funding for healthcare assistance for the children below 19 years, with an income that is below 200% of the national poverty line in 2006 for a family comprised of four people ($40,000) (Peterson, 2006). It is recommendable that, states place rules to help cover the uninsured children as means to avoid crowd out which is as a result of private coverage substituting for public coverage (Carolyn, 2011). In addition, they should evaluate and examine the children to determine their eligibility before enrolling them. Within their national parameters, states are given authority to put in place their own rules to determine eligibility including assets and income that count towards qualification. In 2006, close to 30 states set upper-income qualification limits, at 200% of the poverty line. About eight states had a low qualification limit, while 15 had a higher qualification limit.
Children health support in CHIP can be provided by states via Medicaid or a detached program (Carolyn, 2011). States that go for Medicaid usually expand their subsisting benefits as well as delivery systems in order to cover children originating from higher income families. For the reason that Medicaid warranties coverage to qualified children, those in states using Medicaid for CHIP remain entitled for coverage, despite in cases where CHIP funding come to an end (Henderson & Steinberg, 1999). States that opt for detached programs might take up diverse delivery systems and benefit packages for intended children from low income families, dependent on standards. However, children in detached plans are not eligible for coverage. In this case, states might enforce waiting lists in case of the unavailability of federal funding for CHIP. In 2006, eighteen states had detached programs and eleven states had Medicaid SCHIP programs, whilst 21 states combined the two (Carolyn, 2011).
Despite the fact that CHIP provides flexibility in design, benefits have to meet specific standards. In order to achieve the required standards, states can provide:
* Benchmark coverage: this is a package significantly equal to Blue Cross Standard Option (a Federal Employee Health Benefits Program), or a health employee plan.
* Benchmark equivalent coverage: this is a plan having a cumulative actuarial significance as a minimum of a benchmark plan.
* Subsisting broad coverage, which is the option, put in place by states that had extended coverage before CHIP.
* Secretary permitted coverage, and this may encompass the Medicaid package
(State Health Access Data Assistance Center, 2006)
States that go for `benchmark equivalent coverage` are necessitated to offer specific services, including specific amounts of drug coverage and well child care. These optional benefit packages are important to limit premiums and cost sharing. For instance, cost sharing is nominal for families whose income level is less than 150% of the poverty level, whilst in other families, cost sharing plus premiums, is up to or less than five percent of wages (Woolridge et al, 2005). Research indicates that in 2003, fourteen states employed benchmark plans 21 states used Secretary-approved plans and four states employed federal employees plan (Zuckerman & Cook, 2006).
Financing of health of children support under CHIP is done the state as well as the federal government. Unlike Medicaid, the state governments contribute 30 percent whilst the federal government contributes 70 percent of the cost of the program (Carolyn, 2011). The main aim is to encourage the states to take part in the voluntary program. The matching payments for CHIP depend on state supported caps. Certain limits for cumulative, yearly federal payments for the program for the years 1998 to 2007 were included in the law and the aggregate for this period was 39 billion U.S. dollars. The yearly federal limit, which is divided on the states, depends on various factors including `state cost factor` and `number of children`. The cost factor of the state takes into consideration geographic dissimilarities in incomes while the number of children delineates those children who are not insured (Broaddus & Park, 2006). The law consists of ceilings and floors, and this aims at limiting disparities in the state particular allotments annually. State allotment can be employed in the present financial year, and if unspent can be used in the following years. In 2005, Vermont received the least state allotment of five million U.S. dollars whilst California received the biggest allotment of 667 million U.S. dollars (Ross & Cox, 2005).
CHIP has a system of redistributing unspent federal allotments to states that may require greater amounts. The finances from federal allotments that qualify for redistribution are those which have not been spent for three years (Peterson, 2006). All the unspent allotments are divided amongst states with deficits or that which have utilized all their allotments. States are given a period of one year to spend the redistributed funds, after which the unspent funds are returnable to the treasury. In specific years, states were allowed by Congress to keep their allotment funds for more than three years, while the redistributed amount was limited so as to keep the unspent finances in the system. Through this recycling, states by and large had enough money to maintain coverage, although annual spending incurred by some states was more than their yearly allotments. After 2006, state spending on the program surpassed the overall federal allotment implying that available funds for redistribution went down. In the same year, yearly spending of 38 states went beyond their yearly allotment. Through the amendments of the “Deficit Reduction Act of 2005” by the Congress, which saw an inclusion of 238 million U.S. dollars, the federal government was able to continue funding of the subsisting programs (Peterson, 2006). This amendment was made as the total unspent funds available for redistribution was not enough to fund the programs. In 2007, approximately 17 states faced shortfalls after modification of the redistribution method in the legislation enacted by the Congress in the lame-duck session assisted in filling the shortfalls.
In order to increase awareness thus enrollment, CHIP has stressed on outreach. States are permitted to make use of equal to 10% of their yearly allocation to issues touching on administration and outreach (Institute of Medicine, 1998). The federal government passed policies and guidance between 1999 and 2000, and this promoted generality of the procedures of determining eligibility and redetermination. Through private and public endeavors to increase awareness amongst families of eligible children, this was harmonized. Administrations headed by President Bush and Clinton backed attempts to employ toll-free numbers, social marketing, amongst other ways of encouraging enrollment. Some private institutions have boosted the government`s endeavors in this issue. For instance, the `Robert Wood Johnson Foundation` spent almost 150 million U.S. dollars which covered family and program for children to advance their enrollment.
Impact at Children`s Coverage
The main objective of CHIP is to extend coverage of health to those children from low income backgrounds. From the time when the program was initiated, the enrollment of children has amplified increasingly reaching 6.1 million by 2005 (U.S. Department of Health and Human Services, 2009). The boost towards the enrollment of CHIP was harmonized by a rise of 6.8 million children in Medicaid between the years 1997 to 2004. This increase was linked to various factors which includes simplification and extension of eligibility by states, outreach programs and the 2001-02 economic depression that resulted in a decrease in insurance paid for by the employer amongst low income people, resulting in a rise in children qualified for CHIP (Blumberg, 2004).
The rise in enrollment contributed to a decline in the level of uninsured children. This can be evidenced by statistics which show that, in 1997, the percentage of uninsured children was 22.3% (United States Health Resources and Services Administration, 1998), thereafter, this dropped to 14.9% in 2005 (U.S. Department of Health and Human Services, 2009). At the same time, the rate of uninsured children originating from ell to do families who are not eligible for Medicaid increased to some extent. CHIP principally settled up a significant boost to uninsured children from low income backgrounds. Studies indicate that states which had low reductions in employer coverage, reflected considerable declines in uninsured children, whilst coverage stabilized in states having huge reductions in employer coverage (United States Congress Senate Committee on Finance, 2007). As a result, CHIP assisted in preventing children from going through similar kinds of coverage loss as adults in current times.
The effect of CHIP on the percentage of uninsured children differs by state. Since its implementation, states have experienced a considerable decrease in the levels of uninsured children, with an average decline of twenty percent. Arkansas State recorded the best development, in which the percentage of uninsured children decreased by almost 60 percent between the years 1997 to 2004 (Smith, 2011). Other states that recorded radical improvements were Alabama, Mississippi, and Louisiana. Texas has the highest number of uninsured children though it recorded a considerable decrease in the same. States which had widespread programs before CHIP upheld coverage in spite of reductions in employer coverage.
This research will make use of secondary ways of collecting data. These will include the use of newspaper articles, peer review journals, press releases, policy statements and other publications relating to Children`s Health Insurance Program (CHIP) and how successful it has been since its implementation in 1997. Secondary method of data collection methods is deemed as an efficient way of collecting data, as it offers credible information to the subject matter being handled. This is due to the fact that, it gives researcher opportunities to compare various publications by combining similar thoughts crucial in deriving to the desired conclusion.
It is clear that CHIP helps to extend coverage of health for children from low income families. For instance, since the initiation of this program, the enrollment of children has amplified, reaching 6.1 million by 2005. The boost in the enrollment of CHIP was harmonized by a rise of 6.8 million children enrollment in Medicaid between the years 1997 to 2004. The increase was linked to various factors including: simplification and extension of eligibility by states, outreach programs, and the 2001-02 economic depression that resulted in a decrease in insurance paid for by the employer amongst low income people, resulting in a rise in children qualified for CHIP. The rise in enrollment contributed to a decline in the level of uninsured children. This can be evidenced by statistics which show that in 1997, the percentage of uninsured children was 22.3% and this dropped to 14.9% in 2005. States have experienced a considerable decrease in the levels of uninsured children, with an average decline of twenty percent. Arkansas State recorded the best development, in which the percentage of uninsured children decreased by almost 60 percent between the years 1997 to 2004. This rise is linked to certain given factors. For example, in order to increase awareness thus enrollment, CHIP has stressed on outreach. States are permitted to make use of equal to 10% of their yearly allocation to administration, outreach, as well as other health linked activities. Besides, both private and public institutions have endeavored to increase awareness amongst families of eligible children.
In spite of the increase in coverage for children after the implementation of CHIP in 1997, studies indicate that approximately nine million children below nineteen years were not insured in 2005. Besides, the same year recorded a national percentage increase in the number of uninsured children for the initial instant since the creation of the insurance program. It is also apparent that more than sixty percent of children who are not insured are qualified for either CHIP or Medicaid. However, enrollment in the programs has been low, and this is attributed to enrollment barriers as well as misunderstandings regarding eligibility. A survey carried out in 2002 showed that more than 90% of parents of uninsured children and those who earn low incomes are familiar with CHIP however just 57% knew that eligibility and welfare were not linked. Enrollment barriers are evident, and they can be proven by instances such as the loss of about 39,000 children from the health insurance program, which was contributed by the failure of the parents to complete the novel application as required by Washington. Amongst the children who lost coverage, 90% were qualified for CHIP. The current economic deceleration saw various states reinstating and adopting procedural barriers to redetermination and enrollment as ways of reducing the number of covered children and reduces costs.
It is apparent from the studies carried out with regards to Children`s Health Insurance Program that generally to having health insurance coverage, enrollment enhances health care accessibility. In the same regard, children who were uninsured, enrolled children in Medicaid indicate low unaddressed health care needs (2 percent vs. 11 percent). It is also eminent that the unaddressed health care needs amongst uninsured severely ill low income children who acquired Children`s Health Insurance Program coverage declined by 8 percent, which was a high proportion as compared to the newly insured children who did not suffer severe illnesses.
Besides, the children who were uninsured and acquired coverage through the Children`s Health Insurance Program received a comprehensive health care. Their parents reported that, as a result, they experienced enhanced communications with the doctors of their children and they had better access to the health care givers. The racial inequalities preventing the uninsured children to access health care were reduced, and these children enrolled with Children`s Health Insurance Program. It is reported that the program is successful in all areas evaluated. Since the program was established, it has increased the children`s enrollment to 6.1 million in the fiscal year 2005.
Resultantly, the proportion of the uninsured children dropped to 14.9 percent from 22.3 percent between 1997 and 2005. By the use of improved coverage, around 9 million children below 19 years had not been insured by 2005. Certain reasons are given as to why many children were not enrolled for the health care services. They include misunderstandings regarding eligibility and enrollment barriers. As such, many of these children had unattended health care needs. Despite the program being a success, it has had its flaws in that its success in enrollment for children has come up against its national funding limits.
It is true to conclude that the Children`s Health Insurance Program was enacted swiftly and comparatively smoothly. The main reason why the program was designed is so as to provide insurance to the children in families earning modest incomes that are extremely highly eligible for Medicaid.
This paper has focused on evaluating whether the program has been a success or not. Basically, the program has had a significant contribution towards reducing the rate and number of children who are uninsured. It would be suggested that the coverage the Children`s Health Insurance Program offers is fulfilling when looked at from a larger context perspective of fracturing and eroding coverage system that is employer-based. The program has faced challenges especially with the enrollment of the children. They include racial inequalities, as well as misunderstandings regarding eligibility and enrollment barriers. The project has nonetheless worked to minimize them to attain their goals and be successful. However, irrespective of the implementation of the Children`s Health Insurance Program, the number of the uninsured children continued to heighten especially for the families that could not qualify for the program. This means that, though the program been a success, it has had its flaws due to the fact that, its success in enrollment of children has come up against its national funding limits.
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Children`s Health Insurance Program (CHIP) Student`s Name