In a world of otherwise troubling news about our progress as a nation, one of the great successes of our era is that of children’s health insurance coverage. Believe it or not, we are at historic highs for ensuring that children have meaningful health coverage: 95 percent nationally, and 96 percent in Wisconsin. Some of this is due to a robust and safe — for now — Medicaid program. Part of this success, though, is due to a less-well-known program: the Children’s Health Insurance Program (CHIP).
For many years, there existed a gap in insurance coverage for children. Those in families with “good” employer-sponsored private insurance and those who qualified for Medicaid were covered, but many other children were not. In 1997 Congress passed the State Children’s Health Insurance Program (SCHIP; later renamed CHIP). This state-federal partnership allowed states to offer Medicaid-independent insurance programs for children, expand Medicaid eligibility for children, or utilize a combined approach. The provision of affordable, pediatric-specific coverage to almost 9 million children nationally — over 170,000 in Wisconsin — has been very successful. In some states, including Wisconsin, pregnant women are also covered.
“I’ve never heard of this program,” you may say. But in Wisconsin it is known as “BadgerCare Plus.” Each state may choose to locally “brand” their implementation. No matter what you may call it, one fact is clear: Since CHIP's creation, it and Medicaid have reduced uninsured children nationally by 68 percent. Notably, this program originally passed both the House and the Senate in a bipartisan fashion, and has been successively reauthorized several times in the same vein.
While successful, CHIP faces a deadline: On Sept. 30, funding for CHIP will run out unless Congress continues to allocate resources for the program. Without the certainty of a positive funding decision, states are likely to disenroll families or utilize waiting lists in order to avoid accepting children into a plan they can’t afford alone. Accordingly, Wisconsin’s congressional delegation and other members of Congress must band together to pass a bipartisan five-year extension of CHIP funding.
There is another successful program that faces the same funding deadline and that has also received bipartisan support — the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV). Even less well-known than CHIP, this program was created by Congress in 2010 as a federal-state partnership to support the development and implementation of evidence-based, voluntary home visiting programs in early childhood. This program has quadrupled those served since 2012 — serving over 160,000 families nationally — and is aimed at improving both maternal and child health, preventing child abuse and neglect, coaching and modeling positive parenting, and promoting child development and school readiness.
The home visiting programs funded by MIECHV are a classic example of prevention done well — programs that begin early, are customized to the needs of individual families, and that intentionally build skills in parents, all with the payoff of having recipients require less assistance later on. A strong body of evidence shows later costs for health, education, and social services are lowered. Ultimately, this program is an important component of improving the health and economic trajectories of children and families.
As a pediatrician, I see numerous children and families who benefit from CHIP and MIECHV. The recent health care drama in Congress made it clear that Americans deserve far better than partisan, talking-point-based “solutions” that take coverage away from people. It remains to be seen what may come from future bipartisan conversations around reforms to the Affordable Care Act. However, passing robust, full extensions for CHIP and MIECHV is an easy, common-sense first step that Congress can take now.
Preserve these legislative successes. It’s good for children, good for families, and good for our future.
Dr. Dipesh Navsaria, MPH, MSLIS, MD, FAAP, is an associate professor of pediatrics at the University of Wisconsin School of Medicine and Public Health and also holds master’s degrees in public health and children’s librarianship. Engaged in primary care pediatrics, early literacy, medical education, and advocacy, he covers a variety of topics related to the health and well-being of children and families.
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