Expanding Health Coverage for Children Bridges Way to Health Care for All

When Congress places the CHIP expansion bill on Obama's desk next week, it will be completing the unfinished business of the last Congress. But we must then move forward with real health care reform.
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In the next week, we expect Congress to put legislation expanding the Child Health Insurance Program (CHIP) on President Obama's desk. With his signature our new president will take care of unfinished business from the last Congress and expand health coverage to approximately 4 million. He will be righting one egregious wrong of President Bush who vetoed this legislation two years ago, while also providing critically needed financial help to states. But this CHIP legislation designed for passage during the Bush administration is neither the comprehensive child health reform truly needed in 2009 nor President Obama's promise of health coverage for every child in America.

Once Congress enacts the CHIP expansion, we hope it will move to the next chapter on child health care in America and make the president's promise a reality. We say this as individuals who have been big supporters of CHIP since its inception and have worked tirelessly to extend coverage to more and more children. CHIP was important legislation passed in 1997 that expanded health coverage to millions of children over the past 11 years. But now is the time to enact real health care reform that will provide coverage to every child in America.

With the legislation President Obama will sign into law this month, 5-6 million children will still be without any health coverage and millions more will remain under-insured with coverage that falls short of meeting children's health needs. Children are subject to a 50-state lottery of geography in which some states to do well for children and others not. Six million of the nine million uninsured children currently eligible for CHIP or children's Medicaid are not enrolled because many states have adopted policies and procedures that block coverage or make it very difficult. A child will lose eligibility in North Dakota if his parents earn more than 150% of the federal poverty level while in twelve states and D.C., families can earn twice that amount and still be covered. Alaska and Illinois have a 12-month waiting period for some children to get coverage, and Mississippi, Utah, and Kentucky require onerous face-to-face meetings to get or keep coverage. States can even decide not to cover critical dental, vision, and mental health services. And in this economic downturn, at least 19 states have cut or are considering cutting services to children.

One thing we've learned over the years is that children must have comprehensive, guaranteed coverage that does not differ from state to state. And we certainly don't want to prolong a system where children lose access to affordable health care on their 19th birthday and have to wait until they're 65 and eligible for Medicare before they have health security. CHIP's strengths and weaknesses can become guideposts for how to create a sound child health system within overall health care reform that guarantees comprehensive, affordable health coverage to all, including national standards of health benefits that meet each person's age-appropriate needs. The cost of coverage should be based on family income without financial barriers that discourage people from getting needed care. The coverage system should include rules to assure that health insurance companies are not allowed to charge higher rates for coverage based on a person's age or health status or because a woman is of child-bearing age. And we believe we should offer Americans a choice of private or public health coverage to assure everyone access to a health plan that is accountable to public health and not to increasing profits. Each of these principles is included in the health care plan that President Obama championed while campaigning.

When Congress places the CHIP expansion bill on President Obama's desk, it will be completing the unfinished business of the last Congress. We must now move forward with real health care reform for all children - and for everyone in America - in 2009. With his signature, President Obama will be taking a first step towards fulfilling his campaign promise of affordable, accessible health care for all in 2009.

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