President Franklin Delano Roosevelt, founder of the National Foundation for Infantile Paralysis (which later became the March of Dimes), wrote in a November 1942 letter to Basil O'Connor, the president of the organization, that " . . . nothing is closer to my heart than the health of our boys and girls and young men and young women. To me it is one of the front lines of our National Defense." Congress should keep Roosevelt's words in mind as it considers the reauthorization of the State Children's Health Insurance Program (SCHIP.)
In New York State, 388,178 children are enrolled in SCHIP and 362,000 are uninsured. Congress is expected to reauthorize SCHIP this year and the March of Dimes believes this is a perfect opportunity to take these steps to make the program even more effective:
First, Congress should provide the resources necessary for states to enroll all eligible children. Today, more than 6 million children rely on SCHIP for their health insurance and nearly 2 million (19 percent) of the 9 million uninsured children are eligible for SCHIP but not enrolled. The National Academy of Sciences' Institute of Medicine has shown that health insurance status is the single most important influence in determining whether health care is accessible to children when they need it.
Second, allow states to enroll pregnant women who meet SCHIP income guidelines. Numerous studies have shown that health insurance coverage is essential to ensure that pregnant women have access to the medical care they need to give their babies a healthy start in life. Currently, states can enroll pregnant women in SCHIP only if they obtain a federal waiver or follow a regulatory approach that fails to cover the scope of clinically recommended maternity care. Congress should amend the SCHIP law to give states the option to enroll pregnant women who meet the program's income guidelines.
Third, Congress should improve access to medical services for children with special health care needs. Under current law, a child must be totally uninsured in order to qualify for SCHIP. A better approach would be to permit families with some private coverage to enroll their child in SCHIP as well so that together, the two plans can provide the scope of benefits that meet their child's medical needs. Because private plans would cover a portion of the health costs incurred by these children, allowing families to combine private and public coverage would make it possible for states to stretch their SCHIP dollars to reach more children.
Fourth, state monitoring and reporting on the quality of care provided to children enrolled in the program should be improved. Monitoring the quality of preventive and chronic care services for the pediatric population would enable parents and policy makers to better assess and, where necessary, improve the quality of care provided through this program.
Christine Scott is health educator for the Buffalo Prenatal-Perinatal Network, and a March of Dimes volunteer.