Expanding Public Health Insurance for Children
The most significant source of health insurance for low-income children is Medicaid, a program jointly funded by the federal and state governments and administered by the states. Over the past fifteen years, Medicaid has undergone substantial changes, most aimed at increasing the availability of public health insurance for children. Prior to the mid-1980s, Medicaid had extremely restrictive eligibility criteria and was tightly linked to the receipt of cash assistance. Consequently, many low-income children were ineligible and uninsured. Uninsured individuals are much less likely to obtain health care and often obtain what care they do receive in relatively costly emergency room settings.1 According to data from the National Medical Expenditure Survey, in 1987 more than half of all uninsured children with asthma and one-third of uninsured children with chronic ear infections did not see a physician (Monheit and Cunningham, 1992). Since the mid-1980s, however, there has been a major expansion of coverage to children previously ineligible, a break in the link between cash assistance and health insurance, the introduction of a new program (the State Children’s Health Insurance Program), and a move to place greater authority for public health insurance programs in the hands of the states. These changes, the most far-reaching since Medicaid’s inception in 1965, affect the lives of a substantial number of American children—according to Census Bureau data, 14.5 million children (approximately 20 percent of all children) report being covered by Medicaid in 1999 (the number of children receiving Medicaid according to administrative data is higher—18.3 million in 1998), and research shows that an even larger number of children were eligible for public insurance.
KeywordsCurrent Population Survey Medicaid Expansion Medicaid Eligibility Private Coverage Cash Assistance
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