States Expand Government-Funded Health Care for Children

Many states are making more children eligible for government-funded health insurance even as President Bush's health chief says families are relying too much on public money for the coverage.

The goal of the states is to allow more middle-class families to participate in the State Children's Health Insurance Program. The states are raising income limits so families once shut out because of their earnings now can qualify.

When the program began a decade ago, states could offer coverage to families whose income was not more than double the federal poverty level. Today, for example, that threshold is $41,300 for a family of four. A few states use a Medicaid-based formula that lets them insure more children than under the income limit.

Already, 18 states exceed the 200 percent level, with federal permission. Five more, plus the District of Columbia, could join the list this year, according to a survey by Georgetown University's Center for Children and Families.

New York lawmakers recently set an income limit of up to $82,600 for a family of four. Eligible families get some government help in buying insurance. The poorer they are, the greater the subsidy.

Other states considering significant expansions in eligibility include California, Ohio and Oklahoma. Florida and Oregon are considering modest expansions, the center reported.

Health and Human Services Secretary Mike Leavitt said if other states followed New York's proposal, it would mean that 71 percent of the nation's children would be on "public assistance."

"SCHIP is being proposed in the spirit of the expansion of health coverage. But that isn't the reality," Leavitt said last week. "For every 10 people that go on a publicly funded plan, six of them leave a private plan."

Jocelyn Guyer, deputy executive director of the university center, said states have determined that public health insurance is better than no insurance at all. She said a range of studies shows that most children entering the program would otherwise lack coverage.

"State leaders are moving in a very different direction than the Bush administration is talking about," Guyer said. "They see that even moderate-income families increasingly find that coverage is simply unaffordable, and that it's appropriate to have some subsidy."

Guyer's organization conducts research but also advocates for more federal money for children's health insurance.

In 1997, Congress provided the children's insurance program with $40 billion over 10 years. The program now covers more than 6 million people, including about 640,000 adults. The families make too much to qualify for Medicaid, but not enough to afford private insurance.

Congress probably will renew the program this year, with a contentious debate expected over how much money to spend.

A large expansion of children's health insurance is a priority for Democrats. They want to spend $75 billion over five years; the Bush administration is seeking less than half that.

States match federal dollars with their own. On average, states spend $30 for every $70 from Washington.

The administration wants the insurance program to help just low-income families. Leavitt said all states should enact plans that would provide other families with access to more basic insurance policies.

Those policies may not be as comprehensive as some families would like. For example, he said, they may not cover treatments once the care reaches a certain expense, but the policies would provide some protection.

Leavitt noted that Michigan was working on a plan that would pay as much as $35,000 in a year for health costs and could serve as many as 1.1 million people. Tennessee is developing what Leavitt described as a "very basic" insurance plan. The plan would cost $150 a month — $50 from the insured, $50 from the employer and $50 from the state.

Guyer said many states considering expansions will scrap them unless Congress acts this summer to provide more money.

She cited Ohio and Oklahoma. According to the center, both states are considering proposals that would increase eligibility limits so families of four with an income under $61,950 could participate.

"It just comes down to the reality that in the absence of federal money, they really can't do this," Guyer said.

The Senate Finance Committee may take up a children's health insurance bill as soon as next month.

Legislation introduced last week by Sens. Edward M. Kennedy, D-Mass., Jay Rockefeller, D-W.Va., and Olympia Snowe (news, bio, voting record), R-Maine, would allow states to expand coverage to families earning less than triple the poverty level, or $61,950 for a family of four.

Kennedy said the program "has been a great success, but 9 million children in the United States still lack health insurance. This bill will make a real difference in their lives."