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Report: Quality of Care States Provide Varies Significantly

By Annie Johnson, CQ Staff

June 2, 2008 -- A recent Commonwealth Fund report shows wide disparities in individual states' ability to provide affordable, quality health care to children, highlighting what some consider the inadequacy of new standards for funding the State Children's Health Insurance Program, or SCHIP.

"Unlike adult health care in this country that is largely driven by government policy, children's health care is generally a state-run program," said Edward Schor, who leads the Fund's Child Development and Preventive Care program. Schor also is a pediatrician.

A 2007 directive from the Bush administration said if states wanted to expand eligibility for the SCHIP program to children in families with incomes more than 250 percent of the federal poverty level, they would have to prove that 95 percent of eligible children from families earning less than 200 percent of the poverty level were already enrolled in SCHIP or Medicaid.

"One of the bottom lines of this report is that states can't do this alone," said Karen Davis, president of the Commonwealth Fund. "They need help from the federal government and they certainly don't need to be stymied."

While no single state finished top in every measured category—access, cost, quality, equality, and potential to lead a healthy life—states in the northeast and upper Midwest tended to rank higher in multiple areas, the report found. States in the south and southwest generally had lower scores.

"Many of the best performing states have been pioneers in terms of using public programs to cover uninsured children and improve health outcomes," said a spokeswoman from the House committee on Energy and Commerce. "These positive results highlight the folly of the Republican refusal to reauthorize a robust children's health insurance program last year."

Mostly, Schor and Davis said, the report highlights improvements that could be made to the national children's health system if all states performed as well as the top finishers identified in the report.

For example, Schor said, if the United States had health care coverage for all children at the level of Michigan, there would be an additional 4.6 million children covered.

Among the top-ranked states were Iowa, Vermont, and Maine, which ranked 1st, 2nd, and 3rd in their overall ability to provide children's health care. Oklahoma, the report showed, ranked 51st in overall care and in access to care.

Access, Schor said, is the most important factor in beginning to improve health systems.

"The key request for any discussion about health or health care for children needs to start with do they have access to health care?" he said.

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