Publications on Child Health

In early 2003 San Mateo County, California launched the Children's Health Initiative (CHI), to ensure that all children have access to comprehensive health insurance coverage. Healthy Kids covers uninsured children below 400 percent of poverty and primarily serves poor, undocumented Latino children. A survey of parents of Healthy Kids enrollees found that in the first year of enrollment, children experienced improvements in access to and use of medical and dental care; a reduction in missed school days due to health problems; reduced unmet need; increased parent confidence in getting care and satisfaction with quality; and reduced financial worries. Moreover, use of preventive and dental services continued to improve during the children's second and third years of continuous enrollment.

The Los Angeles Healthy Kids program, during its first four years, extended comprehensive, affordable coverage to over 40,000 poor and vulnerable children, and improved their access to and use of care. Yet, the program also faced serious challenges, primarily related to financing. Funding for children ages 6 through 18 ran short in spring 2005 and Healthy Kids capped their enrollment. State health reform efforts that could have stabilized funding for the program have failed. Based on interviews with over 40 stakeholders, this case study analyzes the complex challenges that the Los Angeles Healthy Kids program faces at this critical juncture.

As efforts to reauthorize the State Children's Health Insurance Program (SCHIP) failed in 2007, Congress settled on a short-term extension of the program. The issues that proved contentious in the SCHIP reauthorization debate will likely be revisited when Congress again takes on SCHIP reauthorization later in 2008 or early 2009 when the extension is set to expire. Instead of seeing the reductions in uninsurance among children that were projected under the vetoed SCHIP reauthorization bills, the number of uninsured children will likely increase, at least in the short run. Without strong growth in public coverage, more children are apt to join the ranks of the uninsured, which increased by 1 million over the past two years.

A longitudinal survey of parents of enrollees in the Los Angeles Healthy Kids Program has found that the program had significant positive impacts on children’s health and access to care. Children experienced improvements in access to and use of ambulatory, specialty and dental care; reduced unmet need; increased parent confidence in getting care and satisfaction with quality; and reduced financial worries. Most important, children’s health status improved, as perceived by parents and according to several measures. Healthy Kids covers uninsured children below 300 percent of poverty who are ineligible for Medicaid or SCHIP, and primarily serves poor, undocumented Latino children.

The number of uninsured Americans increased by 3.4 million between 2004 and 2006, despite improving economic conditions. In the first four years of the decade, during a period of economic recession, the number increased by 6.0 million. The dominant factor in both periods was a decline in employer-sponsored insurance coverage. Although the recent decline was less than that experienced from 2000 to 2004, growth in public coverage was small, and the number of uninsured people increased by 1.0 million children and 2.4 million adults. Employer coverage declined most for self-employed or small-firm workers, in the South, and among noncitizens.