The Federal Government’s Current Role in Healthy Child Development
Children need access to medical care to treat illness and injury and provide preventive and developmental services. Children’s health care needs are different from those of adults—their bodies and minds are changing and developing at a rapid rate—but most health coverage is based on an adult health-care model.
Historically, most children have received health coverage through their parents’ group health coverage, but rising health costs have made family health coverage less affordable to both employers and employees.
The federal Medicaid program, established in 1965, provides states with matching federal funding to cover the costs for health care services for low-income children, their parents, and persons with disabilities, including nursing home care. Originally, Medicaid eligibility for children was linked to eligibility for welfare programs, but changes have expanded the opportunities for states to cover children based upon family income.
In 2000, the federal government also established the Child Health Insurance Program (CHIP) to provide additional financing to states to cover children above state Medicaid levels, either through the Medicaid program itself or a state-administered program. States have set eligibility levels for participation, and most states now cover children and pregnant women under Medicaid or CHIP at least up to 200 percent of the federal poverty level ($46,100 for a family of four). Currently, half of all participants in the Medicaid program are children, but adults with disabilities and long-term care needs who are on Medicaid account for about 80 percent of program costs.
Many families who used to be able to depend on employer-sponsored health coverage for family coverage are no longer can. Employer-based health coverage for children has declined over the last 30 years, but increases in publicly funded coverage for children under Medicaid and CHIP have reduced the proportion of uninsured children in the United States. Today, over one-third of all children in the United States, and half of all births, are covered under Medicaid or CHIP. A number of provisions within the Affordable Care Act of 2010 expand coverage for children, particularly through health exchanges and health navigators who seek to enroll children and adults in health coverage.
One-third of all children in the U.S. receive health coverage through Medicaid or the Child Health Insurance Program (CHIP). While 10 percent of children remain uninsured, the rate of child health coverage has increased as a result of these public programs.
What federal actions should be taken to ensure that all children have coverage that meets their health and nutrition needs?
Medical coverage, however, is only one aspect of ensuring children’s health and development. Children need safe homes and neighborhoods, sanitary living conditions, nutritious foods, opportunities for exercise and nurturing families to maximize their health and development. The federal government also supports public health programs, including the Maternal and Child Health (MCH) Block Grant program, and the Vaccines for Children (VCF) program, to provide preventive and public health services. A number of federal demonstration programs seek to improve children’s health and development, including ones to address the rise in obesity among children and ones responding to children with special health care needs, including oral and behavioral health needs.
In addition, there are a number of child-focused food and nutrition programs designed to reduce malnutrition and promote healthy eating. The Women, Infants, and Children (WIC) program, school lunch and breakfast programs, and the child care food program all incorporate nutritional guidelines in providing meals and food for children.
Children’s Health and Challenges Ahead
In addition to the 8 million children who are still uninsured, the United States faces significant challenges in ensuring the health of the next generation. For the first time, America’s children face the prospect of growing up less healthy, having more debilitating and costly chronic health conditions as adults and living shorter lives than their parents. Diet, exercise and exposure to environmental toxins all play a role in the rise in obesity, diabetes, asthma and other health conditions. There are major child-health disparities by income, race and geographic location whose presense compromises the nation’s future. While current health care costs for children remain small in relation of those for adults, the future costs for treating their health threatens the financial viability of the current health care system as well as the health and productivity of American society.
Context for Federal Electoral Dialogue
The federal government currently plays a major role in providing health insurance and preventive health services for children. At the same time, the federal government is grappling with rising health care costs in both Medicare and Medicaid.
Public opinion polls show strong support for ensuring that children, in particular, are covered by affordable health insurance, but they also recognize the need to contain current and future health care costs. They are concerned about the overall health of children and would like more attention to prevention.