Growing body of evidence supports the value of child health insurance

Congress was unable to pass legislation renewing and expanding the federal State Child Health Insurance Program (SCHIP) last year, so it was extended long enough for the new administration and Congress to take on the issue.

Pediatric leaders are hoping that the 111th Congress and the new White House can work together to put children's health issues -- particularly children's health insurance -- on the national agenda.

Peter Szilagyi, M.D., M.P.H., editor of Academic Pediatrics, immediate past president of the Academic Pediatric Association (APA) and Chief of General Pediatrics and Professor of Pediatrics at the University of Rochester Medical Center, published a commentary along with other APA leaders that reviews more than a decade of research on SCHIP and child health insurance in this month's Academic Pediatrics.

About 12 percent of children nationwide don't have health insurance, adding up to about 11 million children. Research shows that a lack of health insurance for children is associated with delays in receiving needed health care, a lack of preventive, acute or chronic care, a lower quality of care and, in many cases, poor health outcomes. Studies have also shown that health care for children costs about 1/10th as much as healthcare for adults.

"A growing body of evidence supports the value of paying increased attention to children's health issues, especially for children who are vulnerable because of chronic conditions or social circumstances," Szilagyi wrote.

According to the review of research, among the evidence to support providing eligible children and adolescents with SCHIP is:

• improved access to care
• more appropriate use of care
• better quality of care
• improved outcomes among children with asthma
• improved outcomes among other children with special health care needs
• improved outcomes among adolescents
• reductions in some preexisting health care disparities (i.e., racial gap in access to care)

Last year, Congress had also considered expanding SCHIP to cover children living in families between 200 and 400 percent of the federal poverty level. One of the hitches to passing legislation last year was the belief that the expansion of SCHIP to children would cause families to switch from private insurers to SCHIP or "crowd out." A study of crowd out in New York State by Dr. Laura Shone, DrPH, showed that the incidence of true crowd out was very low and that most families who switch from private insurance to SCHIP do so with a major life event, such as job change or loss and divorce. Another study by Dr. Shone and Rochester colleagues showed that many uninsured children between 200 and 400 percent of federal poverty level also go without needed health care. Thus expansion of SCHIP would benefit many needy children.

"SCHIP has existed for more than a decade now, and through scientific research, we've been able to see that providing insurance to children does substantially improve the health of these children," Szilagyi said.

"The scientific evidence for child health insurance is clear, continued Dr. Szilagyi. Health insurance is important for children. We hope that the new administration and Congress act rapidly to renew and expand SCHIP, and then to guarantee health insurance for all children."