Low-Income Children Could Be Worse Off After Health Care Reform

November 7, 2009

Last Wednesday, hundreds of concerned citizens answered the Children’s Defense Fund’s call to join a “stroller brigade” to the U.S. Capitol. Other brigades strolled in at least 16 communities across the U.S.

These brigades were to demonstrate grassroots support for “comprehensive, affordable, accessible health care for all children, no matter where they live.” This is by no means an inevitable result of federal health care reform.

CDF warns that the health care reform bills Congress is debating give short shrift to the needs of millions of uninsured and under-insured poor and near-poor children. They could, in fact, leave many worse off than they are now.

CDF and the “champions for children” it’s organized want Congress to do three things.

1. Guarantee all children access to the full range of health benefits they need, i.e., the early and periodic screening, prevention, diagnosis and treatment (EPSPDT) services children can get under Medicaid. There are four related concerns here.

  • Only some children enrolled in the State Children’s Health Insurance Program (SCHIP) get comparable benefits because states can offer more limited coverage.
  • Under the bills now pending, children whose families purchase insurance through the newly-created exchange will not be covered for all EPSPDT services.
  • These children will eventually include those enrolled in SCHIP. The bill the House will vote on would sunset the program in 2013. The final Senate bill will probably extend it to 2019. But even before then, SCHIP children will be shifted to the exchange if a state runs out of funds for the program.
  • Premiums and out-of-pocket costs in exchange plans will be higher than what families pay under SCHIP. As a study for First Focus shows, the difference could be as great as 33%.

2. Eliminate the unjust lottery of geography. Here again, the problem is that SCHIP benefits and eligibility vary from state to state. In some states, SCHIP is structured as an expansion of Medicaid, thus ensuring EPSPDT benefits. Other states have separate, more limited programs. Twenty-two states permit enrollment of children up to 300% of the federal poverty line. The eligibility cap in the remainder is lower.

So what CHN wants in the final health care reform package is mandatory coverage under SCHIP for all children under 300% of the FPL, federal funding to ensure states can enroll all eligible children and, I infer, a nationwide benefits standard comparable to EPSPDT. It also wants SCHIP retained until the alternative can be shown to provide coverage at least as good.

3. Address bureaucratic barriers that keep children eligible for Medicaid or SCHIP from getting the care they’re entitled to. CHN says that complex application and enrollment processes and frequent renewal requirements now keep about two-thirds of eligible children out of these programs. It wants Congress to require a simple, streamlined process.

Those of us who didn’t stroll can support CHN’s agenda by signing on to its letter to Members of Congress.

As Washington Post columnist Harold Meyerson observes, “children–most particularly, children of non-affluent parents–have no clout whatever in the political process.” They depend on us and venerable champions for children like CHN.

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Too Many Juveniles, Not Enough Justice In Our Juvenile Justice System

March 30, 2009

Last week, the Georgetown University Journal on Poverty Law and Policy co-hosted a symposium on “the intersection of juvenile justice and poverty.”

Speakers came at the topic from different angles, but there was remarkable consensus on the big picture. To wit, there are too many juveniles and not enough justice in the juvenile justice system.

Everyone who spoke agreed that the essential thing is to keep youth out of the system because it tends to produce adults who cycle in and out of prison or, at the very least, subsist on the margins of society.

And, though not much was said on this score, the juveniles who are kept out are mainly those whose parents can afford private attorneys, plus those whose white, middle-class background inclines school officials, law enforcement officers and others to let them go with a warning. (Gun possession in school is a partial exception here, but that’s another story.)

Elements of the juvenile justice system can be improved. For example:

  • Reform schools and the like could provide better education, training, health care and supportive services that would equip their charges to return to school or get a job when released.
  • There could be more and better programs to help discharged youth reintegrate.
  • Schools could be required to eliminate barriers they’ve erected to keep discharged former students from re-enrolling.

But, the bottom line, speakers said, is that the juvenile justice system is intrinsically harmful because both detention and the institutionalization that often follows are traumatic and disrupt normal development.

So we need to focus on prevention. This will involve broad-based community programs that address risk factors from birth–or even earlier. And these programs will have to integrate families, schools, health care and social services, housing and community development programs.

A tall order. The research is there and so are promising models. There are pockets of federal funds that can be tapped.

But, as a nation, we are still focused on deterring anti-social conduct by punishing offenders–youth and adults alike. And punishment generally means incarceration, especially if you’re poor.

So we’ll need a major policy shift and a whole new level of commitment to prevent the ongoing waste of human potential that our way of handling juvenile lawbreakers perpetrates.

Children’s Defense Fund has launched a campaign to end our “cradle to prison pipeline.” It’s got action steps for us as individuals and for our communities, organizations and government agencies. There’s a lot to do. But the cost of not doing it is enormous–and heart-breaking.