For children, especially those in poor families, the situation is particularly grave, with over 11 million uninsured. This number represents an increase of 2.5 million in the decade from 1987 to 1997 alone. Many are eligible for Medicaid, the health insurance for very low income Americans jointly funded by the states and the federal government. A number of states, however, have been slow to enroll themor eligible poor adults, for that matter. Part of the blame lies with welfare reform. Adults pushed into the workplace were often dropped from Medicaid (and food stamps too) along with their children, without being told that they might still be eligible. In an effort to provide insurance for lower income children whose families are not poor enough to qualify for Medicaid, the president signed legislation in 1997 that created CHIPthe Child Health Insurance Program. The program allows families with incomes up to twice the poverty level to qualify. The goal at the time was to enroll five million children; but with barely two million enrolled so far, reaching the goal still lies in the future; thus CHIP, like Medicaid, remains an underutilized resource.
Sharon Daly, deputy director of Catholic Charities USA, told America that in the case of both Medicaid and CHIP, daunting barriers existfor example, long and complicated forms that applicants must complete. "Many states make it so hard," she said, not only in terms of the forms themselves, but also by the requirement that applicants must take time off from their jobs for the face-to-face application interview. Only a few states, she added, have short forms that can be submitted by mail.
What, in the midst of this picture of lagging health coverage, are the two major candidates saying? Mr. Gore has long been a strong advocate of expanding health insurance for children. In a speech in Los Angeles in 1999 he promised, "If you elect me president, I will ensure that by the year 2005, every single child in our country has full access to affordable coverage." And in fact, according to Ms. Daly, it is likely that Congress will expand coverage for childrenand make it possible for parents to be enrolled in CHIP too. A study by Families USA has found that children are more likely to be enrolled if the whole family qualifies for coverage. At the other end of the age spectrum, Mr. Gore would allow people aged 55 to 65 without health insurance to buy into Medicare, with free coverage for low income Americans. He would work toward Medicare expansion in another way too: to cover the high cost of the kinds of prescription drugs especially used by senior citizens. The prices for such drugs have increased more than consumer prices in general.
As for Mr. Bush, he favors a market approach to expanded coverage. He has proposed a tax credit of up to $2,000 per family (and $1,000 for individuals) to allow them to choose their own health plan; he has said that even people too poor to pay taxes would receive it. The full amount would be available to those with incomes up to $30,000 per year, with lessening amounts for people earning up to the cutoff limit of $60,000. As critics have pointed out, though, the proposed amounts would fall far short of the cost of an adequate health insurance plan.
Mr. Bush’s record on health issues in Texas, moreover, has been woeful. The lack of insurance among Texans is among the most pronounced in the nation. Hundreds of thousands of poor children remain unenrolled in Medicaid, nor has an active effort been made to enroll the less-poor in CHIP. Indeed, he initially baulked at the Texas legislature’s insistence that children be admitted whose families had incomes up to 200 per cent of the poverty level. He himself had wanted to limit coverage eligibility to a lower amount that would have excluded many children from working-class families.
In the months ahead, both candidates’ health proposals will probably be spelled out in greater detail. But whoever wins the election, it is Congress that will decide to what degree coverage should be provided for those who lack it. We hope that Congress, using the budget surplus projected to be available in 2001, will take the incremental steps necessary to move toward a form of universal coverage that would reduce the number of uninsured Americansespecially children. This is a moral issue that should also be a bipartisan one.