Extending health insurance to uninsured children is perhaps the least controversial public policy goal in Washington. So it sets up a test: If progress is not possible on this issue, progress in our divided, embittered political system is no longer possible at all.
Ten years ago, in a passing fit of bipartisanship, Congress enacted the State Children's Health Insurance Program. Under SCHIP, states are given block grants to cover uninsured children whose parents make too much to qualify for Medicaid (the safety net entitlement for Americans in the worst poverty). Six million children, largely from families of the working poor, now get their health care through SCHIP, which is successful, popular and set to expire later this year. An additional 9 million American children, however, remain uninsured.
Reaching this group of the vulnerable is important, but not easy. Nearly two-thirds of that 9 million, according to James Fossett of the Rockefeller Institute, are already eligible for health care through Medicaid or SCHIP, but their parents haven't filled out the paperwork. Fulfilling the most basic parental responsibilities can't be legislated. Yet some of the problem might be solved through aggressive outreach and marketing by state governments, and by making the SCHIP bureaucracy easier to navigate.
Millions of other children, however, are exposed to risk because the traditional way of providing health insurance through businesses is breaking down. Escalating health costs have caused some firms to drop insurance coverage entirely or to boost costs beyond the reach of many employees. And this problem is working its way up the income scale, from the working poor to the middle class. States have responded by expanding eligibility for SCHIP to higher incomes; this year, New York state increased the threshold to 400 percent above the poverty line.
Some see this as a scandal. But consider the situation of a self-employed single mother in New York who is forced to self-insure. The average policy costs about $13,000 a year. So even if she makes $60,000, she will pay more than 20 percent of her pretax income just on health insurance. Giving her some help is not unreasonable.
Advocates of SCHIP such as John DiIulio at the University of Pennsylvania believe that $3 billion to $5 billion in additional funding a year -- maybe $25 billion over five years -- would make health coverage for children affordable for most American families under the median income. He even offers a slogan: "No child left uninsured."