CAHI Policy Brief: Is There Really An Uninsured Children s Epidemic? Council for Affordable Health Insurance. Introduction

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1 CAHI Policy Brief: Council for Affordable Health Insurance Is There Really An Uninsured Children s Epidemic? Volume 1, Number 1 April 1, S. West Street Suite 400 Alexandria, VA Phone: (703) Fax: (703) Published by the Council for Affordable Health Insurance (CAHI). All rights reserved. Duplication by any means without the expressed written consent of CAHI is prohibited. Introduction During the opening months of the 105 th Congress, several initiatives for the coverage of uninsured children have been proposed by lawmakers. Suddenly, the health care debate tilted toward insuring children and away from families. In this whole kid care debate, the focus is on insurance, not high quality health care. This is a misguided focus. It is based on the erroneous premise that having insurance is a magic spell that automatically grants high quality health care to that individual. Likewise, there is an assumption that the uninsured are all sick and dying, as if the lack of health insurance is a curse. CAHI is not convinced that children of uninsured adults will have better health care even if they have child only coverage if the parents are not also involved in a regimen of regular medical care. The appropriate solution will be found if we focus rather on affordable health insurance and high quality health care for families. The following is true about health insurance for children: Insurance for child-only coverage is available across the country at an affordable price (see table 1). Underwriting standards for children s coverage are very liberal. This is the lowest cost age group to insure, and it is easy to qualify for coverage. The cost of insuring children is the same from birth through age 17 for most insurance carriers. Generally for most insurance carriers, when whole families, including parents, are covered, newborn children are automatically covered, regardless of any health problems. In many cases, adopted children receive similar treatment. Insurance would be even less expensive if mandated benefits were not a factor. States have added over 1,000 mandates, each of which raises the cost of insurance and reduces consumer choice. 1 A tax inequity exists between employees who receive employer-based health insurance and individuals who purchase their own insurance. This makes individual insurance more expensive because individuals pay their premiums totally with after-tax dollars and employees receive their health insurance benefits tax-free. 2

2 Is there really an uninsured children s health insurance epidemic? The push for new insurance entitlement programs is coming from the same groups that lobbied for President Clinton s health care reform plan during the 103 rd Congress. Now these same groups that lost the debate back in 1993 and 1994 want to create an entitlement program similar to Medicare and Medicaid but for children. Hence, the latest reports distort the number of uninsured children into an epidemic when the number of uninsured children has remained relatively stable over the past ten years (see figure 1). According to the Census Bureau s 1995 Current Population Survey, there are 9.8 million uninsured children in this nation. This number represents a decrease from the 1994 estimate of 10.2 million uninsured children. The facts show that for the two most recent years for which information is available, the number of uninsured children actually decreased. 3 Why are there uninsured children? Like adults, children move in and out of the health insurance system either through their parents employer-based health insurance plan, insurance purchased in the individual market, COBRA continuation benefits, or government programs such as Medicaid. When a parent changes to a job that does not provide health insurance benefits or loses a job that provided insurance, the child s coverage also terminates. It is important to note that the statistics used in describing the number of uninsured are snapshots or spells of uninsurance. In fact, most adults who spend time without insurance wait until they get another job, one that provides health insurance, rather than pay with after-tax dollars for health coverage. Fifty percent of the uninsured adult population are without coverage for less than five months, and 70 percent are uninsured for less than a year. Only 15 percent of adults remain uninsured for 24 months or more. 4 The Census Bureau s Survey of Income Program Participation (SIPP) is a more accurate measure of uninsured children than the Current Population Survey, which is designed only to collect information on employment and not health coverage. According to the SIPP (see figure 2): 5 70 percent of children were insured for a 28 month period; 26 percent of children were insured at some time during those 28 months; and Only 4 percent of children were uninsured for the whole 28 months. Will an entitlement health insurance program help reduce the number of uninsured children? According to the 1995 Current Population Survey, there are 9.8 million uninsured children in this nation at any given time children move in and out of this group. Of those 9.8 million uninsured children, 3.3 million live in poverty. The Employee Benefits Research Institute (EBRI) recently reported that despite Medicaid expansions starting in 1990, many Medicaid eligible children have remained uninsured. EBRI cites that a General Accounting Office (GAO) report that found that at least 30% of this nation s uninsured children were eligible under the federal program or about 2.9 million. EBRI goes on further to discuss that parents may not enroll their eligible children in the Medicaid program for various reasons: 6 working and nonworking parents may not know that their child is eligible for Medicaid coverage; some individuals who were once turned down for Medicaid continue to believe they are not eligible for benefits; some parents obtain Medicaid applications but do not follow through with enrollment after learning they must provide documentation of income and birth certificates. It is a reasonable conclusion that many, if not most of the 3.3 million uninsured children who live in poverty, are probably eligible for Medicaid but are not enrolled in the program. Adding another entitlement program to the picture will not Council for Affordable Health Insurance Page 2

3 necessarily reduce the number of uninsured children. Does mandating insurance solve the problem of uninsured children? According to the National Center for Policy Analysis, people choose to remain uninsured because: 7 they believe the system will help them if they get sick; they will not use traditional facilities or doctors and see no need for traditional insurance to cover those bills; some, like the Amish, have religious objections; some do not want to receive welfare; or some are unstable, transient, or simply irresponsible. And there are people that chose not to insure their children if it is not provided by their employer because they have to pay for the health insurance premiums with after-tax dollars. 8 Conclusion Having a working parent is no guarantee that a child will have access to health insurance coverage. Recent figures show that employers are reducing or dropping health insurance benefits. One explanation for the decline in employer-based health insurance coverage is rising health costs. With health insurance reforms moving away from free market reforms and toward federal and state mandated benefits, community rating and guaranteed issue laws, all which increase the cost of health insurance coverage, it is a wonder that more and more employers are dropping their health insurance coverage. 9 According to the National Center for Policy Analysis, 10 state legislatures have already mandated well over 1,000 health insurance benefits for such services as chiropractic care, drug and alcohol abuse and marriage counseling. Studies in six states have found that mandated benefit coverage accounts for between seven and 21 percent of all insurance claims, depending on the state. As a result, the cost of health insurance has increased, and employers have canceled policies, dropped dependent coverage, or increased employee cost sharing leaving more families including children uninsured. The 105 th Congress is considering passage of more mandates, even as it decries the growing number of uninsured children. A recent survey by the Coalition for America s Children shows that children, as a separate population, are not the first group that comes to mind when voters think of the uninsured. Instead, 31 percent think unemployed adults have the most problems getting health coverage, while 28 percent believe seniors and 20 percent believe working parents and their children have trouble getting insurance. Only eight percent cite children as a separate group. 11 The United States currently has two classes of citizens those who are fortunate enough to work for prosperous employers and receive taxfree health benefits on the job, and those who are self-employed or purchase insurance on their own and must pay for coverage with after-tax dollars. The solution to the uninsured is to provide access to affordable health care. Federal tax policy should be modified to treat coverage that is paid directly by individuals in the same way that employer-purchased health insurance is currently treated. This change in tax policy would directly address the problem of the uninsured by instantly making insurance more affordable. Affordability is the key to accessibility. Lower income families could be provided with a voucher to buy health insurance, while middle income taxpayers would be permitted to deduct the full cost of purchasing health insurance coverage. Some studies estimate that this change alone could increase the number of insured people by 10 million, reducing the numbers of uninsured by almost a third, at little cost to the government or the public. 12 There is little doubt that there is a significant number of uninsured children in this country. The debate should be focused on the best method of dealing with this situation. Inflaming legislative Council for Affordable Health Insurance Page 3

4 passion by calling the situation an uninsurance epidemic will only lead to expensive, bureaucratic, entitlement solutions that will adversely affect readily available insurance coverage. Manipulating data in order to bolster such a misguided premise is not a service to consumers and will not lead to reasonable solutions to health care gaps. Affordable solutions for uninsured children and families are currently available in the insurance market place. Government s role should not be to create a new program but to enable working families to have increased access to affordable health insurance. Endnotes 1 Health Benefits Newsletter, State Mandated Benefits Manual. 2 CAHI s Federal Tax Policy: Its Effect on Health Care Costs, Coverage and the Uninsured. 3 NCPA Brief Analysis No. 225 Questions and Answers About Uninsured Children. 4 CAHI s Guaranteed Issue: Guaranteed to Make the Problems in the Small Group Market Worse. 5 Citizens for a Sound Economy s Capitol Comment, No. 152, 2/18/97, Congress Can t Help Uninsured Kids If It Doesn t Understand Them and National Center for Policy Analysis Brief Analysis No. 225, Questions and Answers About Uninsured Children. 6 EBRI Notes, January 1997, Vol. 18, No.1, Characteristics of Uninsured Children. 7 National Center for Policy Analysis Brief Analysis No. 225, Questions and Answers About Uninsured Children. 8 CAHI s Federal Tax Policy: Its Effect on Health Care Costs, Coverage and the Uninsured. 9 CAHI s State Health Insurance Reform: Experience With Community rating and Guaranteed Issue in the Small Group and Individual Markets. 10 National Center for Policy Analysis Brief Analysis No. 225, Questions and Answers About Uninsured Children. 11 The Bureau of National Affairs Health Care Policy Report, 3/31/ CAHI s Federal Tax Policy: Its Effect on Health Care Costs, Coverage and the Uninsured. Council for Affordable Health Insurance Page 4

5 Table 1 Typical Premiums Child-Only Coverage Private Individual Insurance Varying Deductibles, PPO Plan With Copay, 80/20 Coinsurance to $5,000 One Child Two Children Three Children Four or More Children Deductible Deductible Deductible Deductible Region $500 $1,000 $2,000 $500 $1,000 $2,000 $500 $1,000 $2,000 $500 $1,000 $2,000 East South Mid- West Mid- South Southwest West Council for Affordable Health Insurance Page 5

6 Figure 1 Percentage of Uninsured Children Under age 18, % 19% 18% 17% 16% 15% 14% 13% 12% 11% 10% Figure 2 Spells Without Health Insurance for Children (under age 18, between ) 4% 7% 19% Uninsured for entire 28 months Insured for 12 months or less Insured between 12 & 28 months Insured for entire 28 months 70% Council for Affordable Health Insurance Page 6

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