Healthy Kids insurance saves money

By RUSSELL JONES

For the Monitor





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August 08. 2005 8:00AM







I write this to offer another perspective on issues raised by David Irwin's commentary in the July 31 Sunday Monitor and to correct several inaccuracies.



There is consensus among medical professionals and across a broad range of political opinions that all children should have health insurance in the United States. Children are our most vulnerable population. They have no control over whether they have insurance, or over decisions about whether they should seek appropriate care.



There is clear evidence that regular preventive care, including well-child checkups and immunizations, is cost-effective; that is, it effectively reduces the chance the child will have a serious and more expensive illness in the future. There is clear evidence that children without comprehensive health insurance do not get the preventive care they need.



Healthy children learn better and are better prepared as our future work force. Parents with healthy children miss fewer work days.



Mr. Irwin states that the high cost of medical care in this country results from the expansion of publicly funded programs like Medicaid. In fact, most health economists would argue the opposite - that the cost of medical care overall (principally driven by expensive technology, medications, unhealthy lifestyles and an aging population) is forcing employers to drop medical insurance coverage and so forcing government to make up the difference - at least for children.



Even so, covering kids is not a budget buster. Children represent 70 percent of those who receive health coverage through public programs in New Hampshire but account for only 20 percent of the cost. Health economists would also point out that covering the uninsured lowers the cost of health care by reducing the amount of cost-shifting to insurers and employers that results from unpaid services for the uninsured.

It is unlikely that the nurse referred to in Mr. Irwin's commentary can afford to purchase health insurance by herself. The average cost for a comprehensive family policy in New Hampshire is currently over $10,000 per year - an enormous cost for someone making a moderate income.



So-called catastrophic policies do not cover the preventive services so critical to the future good health of our children. As for employer-based insurance - if these children were covered by health insurance through the mother's job, they would not be eligible for the Healthy Kids program.



Eligibility for Healthy Kids is based on family size and income. Currently a family of three (I am assuming this nurse is a single mother with two children) would have to make less than $29,772 per year to qualify for the Healthy Kids Gold program, or Medicaid, and less than $48,276 per year to qualify for the premium-based Healthy Kids Silver program. Families at higher income levels mentioned by Mr. Irwin might be eligible for the Healthy Kids Buy-In program, but this group is not subsidized by public funds.



The growth in the Healthy Kids program since it was expanded is not as great as Mr. Irwin would have us believe. Since 1999, Healthy Kids Gold enrollment has grown from 48,796 to 61,892. The expanded program, Healthy Kids Silver, currently covers 6,944 children.



While it is true that the Healthy Kids Corp. has assisted more than 60,000 children in obtaining coverage, children do leave the program when they obtain private coverage. According to census data for this period of time, coverage of kids through employer-based plans has remained higher than the national average, providing insurance for about 80 percent of New Hampshire children. Still, 17,000 New Hampshire children have no health insurance.



It is important to point out that a major policy change occurred when Congress spurred the expansion of children's coverage through the State Children's Health Insurance Program (SCHIP). In fact, SCHIP was created to address the growing need among uninsured children in moderate-income working families. In expanding access, there was a clear intent to distinguish health coverage programs like Healthy Kids from public welfare programs for the poor, such as cash assistance and food stamps. This is why the federal government directed states to "delink" Medicaid from Temporary Aid to Needy Families -the cash payment welfare program.



The key issue here is not whether families should rely on health insurance programs supported in part by government funding.



It is rather that the rise in health-care costs has made it impossible for moderate-income families to afford health insurance for their children if coverage is not provided as an employee benefit.



While I understand Mr. Irwin's concern about a parent making an employment decision to be eligible for a program where the government pays some of the cost, as a practicing family and public health physician I would hope that every parent would choose health insurance coverage for his or her child over no coverage.



As noted by Mr. Irwin, the Healthy Kids program is a "remarkable" public-private partnership involving the state Department of Health and Human Services, the Healthy Kids Corp., families, hospitals, medical provider groups (particularly the Dartmouth-Hitchcock Clinic and the Behavioral Health Network), Anthem, Delta Dental and the Legislature. New Hampshire has taken practical steps to invest in children's health-care coverage because not only is it the right thing to do, it's the smart thing to do. Our success in covering kids benefits everyone.