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Let's Complete the Job: Expanding SCHIP

Eliot Spitzer

By Eliot Spitzer, Governor of New York State

As the Governor of New York State, one of my highest priorities is ensuring that every child has health insurance. Access to quality health care is critical for children to grow up healthy and be able to learn. My plan to cover the 400,000 uninsured children in New York builds on the State Children's Health Insurance Program (SCHIP) just as that critical program is about to celebrate its 10-year anniversary.

In a testament to our country's aim to do the right thing for children, SCHIP has enjoyed 10 years of broad-based support. The SCHIP program is widely viewed as a successful federal–state partnership. Much of its success can be attributed to the program's design, one of balancing state flexibility with core program requirements. Each state responded by establishing programs that matched their values, politics, health care systems, and fiscal capabilities.

The SCHIP program must be reauthorized before the end of this fiscal year if gains in coverage for children are to continue and not erode. Congress must act in a timely manner to continue the program by not only providing adequate funding to cover all six million individuals currently enrolled nationally, but also to complete the job of ending uninsurance among children. A country as rich and diverse as ours can surely agree that we owe no less to our most vulnerable residents. However, states require adequate, predictable funding and enhanced flexibility to enable them to reach the goal of covering every child.

New York's SCHIP program, Child Health Plus (CHPlus), has been enormously successful. The program started in 1991 and was one of three state programs grandfathered into the federal SCHIP legislation. As of March 2007, nearly 400,000 children were enrolled. As the second largest SCHIP program in the nation, New York reduced the number of uninsured children in the state by 40 percent from 1997 to 2005. We were only one of seven states to achieve a decline of that magnitude. In addition, extensive outreach and more accessible gateways to enrollment contributed to a 30 percent increase in children enrolled in Medicaid.

At this crossroad in the history of SCHIP, New York will guarantee every child in the state access to affordable health insurance. I proposed, and the Legislature recently enacted, an unprecedented expansion of CHPlus to 400 percent of the federal poverty level. As families move up the income scale, they will contribute a higher monthly co-premium toward the cost of their coverage. This ranges from $9 to $40 per month per child. Families with incomes above 400 percent of the poverty level can purchase CHPlus at full cost, a price still below what is available in the marketplace. In addition, the program includes protections against families dropping employer-based coverage in favor of public coverage. We achieved this expansion with full bipartisan support.

Health insurance matters. Studies by the University of Rochester found that children enrolled in CHPlus had better access to care, continuity of care, and quality of care. After enrollment, virtually every child had a regular source of care and over 80 percent received preventive health care. Unmet health care needs among enrollees decreased by more than one third. Parents of children with asthma or special health needs reported a higher level of satisfaction with the care their children received and were better able to access medications. Even more striking was the university's finding that the long-term uninsured and lowest-income children, who were most disenfranchised before enrollment, demonstrated the most dramatic gains in access after enrollment.

Universal coverage for children is the best way to ensure every child has a healthy start in life and can access needed care. By providing subsidized coverage up to 400 percent of poverty, all uninsured families in New York will be able to afford health insurance for their children. Research shows that a program that makes coverage available to every child will be more successful in enrolling uninsured children, especially those low-income children who are currently eligible, but not enrolled.

President Bush proposes to move SCHIP in the wrong direction by limiting the program to children below 200 percent of poverty. This proposal will erode the gains the nation has made in reducing uninsurance rates among children. As Governor, I agree that states should make every effort to prioritize coverage among the lowest-income children. However, I believe, and research supports, that a program available for every child will reach more of the lowest-income children than a program with a capped eligibility level. Moreover, cost of living varies widely across the country. We should not be forced into debating the differences in a family's ability to meet its basic needs at 200 percent of poverty on Long Island compared to the same income in Atlanta, Georgia. Instead we must focus on the more important issue of how, as a nation, we can continue the success of SCHIP and ensure that every child has health insurance and access to quality comprehensive health care.

The views presented in this commentary are those of the author and should not be attributed to The Commonwealth Fund or its directors, officers, or staff.

Publication Details



E. Spitzer, Let's Complete the Job: Expanding SCHIP, Modern Healthcare and The Commonwealth Fund, April 2007