The recession has significantly increased poverty and unemployment, and with those changes there has been a large increase in adults without health insurance. Yet despite those trends, the number of uninsured children in the U.S. dropped by 1 million from 2008 to 2010 (from 6.9 million to 5.9 million), according to a report released today by Georgetown University.
Experts attribute that remarkable improvement to several factors, including federal funding provided to states by the Children’s Health Insurance Program (CHIP) and steps states have taken to expand eligibility for, and simplify access to, Medicaid and CHIP funded coverage. Another significant factor is federal health care reform (the Affordable Care Act), which requires states to maintain income eligibility levels and discourages other barriers to coverage. (Wisconsin’s Department of Health Services is currently seeking a waiver of those requirements.)
The analysis by the Center for Children and Families at Georgetown found that 34 states had a statistically significant decrease in the percentage of uninsured children. Wisconsin was one of only three states with an increase in the number of uninsured children – joining Minnesota and Kansas in that regard – although the apparent growth in our state, from 4.8 percent of children to 5.0 percent, was not statistically significant. For most of the last decade, Wisconsin had one of the lowest rates of uninsured kids, but since 2008 a number of other states have climbed ahead of us in the rankings, and we have slipped to having the 13th lowest percentage of children lacking health insurance.
When one looks at recent trends, Wisconsin compares much more favorably to other states if one measures back to 2007, the year before BadgerCare Plus was implemented. (That is why we fought hard as the CHIP Reauthorization Act was being developed to ensure that federal bonus funding for states with large improvement in enrollment of low-income children is calculated from a 2007 base year, rather than 2008.) BadgerCare Plus enrollment has continued to grow since 2008, as it has picked up the slack while access to employer sponsored insurance shrank – offsetting the gains in public coverage.
The success of other states that have been passing Wisconsin in progressing toward the goal of covering all kids can probably be attributed to more aggressive outreach efforts and the adoption of reforms like 12-months continuous eligibility to reduce churning of children on and off the program.
Wisconsin’s ranking would almost certainly fall far more if the state gets a waiver from federal maintenance of effort requirements. The waiver proposal submitted by DHS is projected by the department to result in more than 29,000 children dropping off the BadgerCare program (which we think is a very conservative estimate). If about two-thirds of those children became uninsured (which we also think is a conservative assumption), there would be about a 30 percent increase in the number of Wisconsin kids without health insurance. That would probably drop us to or perhaps a little below the national median in the percentage of uninsured children.
Massachusetts, which is the model for the national health care reform law, has by far the lowest rate of children without health insurance, at just 1.5 percent.
Jon Peacock
