Not everyone agrees with me on this — especially in Texas — but I believe all kids should have equal access to the healthcare they need.
As a nation, we are a long ways from that. The U.S. is a patchwork of coverage requirements, a fact underlined this week in a new report, Performing Under Pressure: Annual Findings of a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies in Medicaid and CHIP, 2011-2012.
There’s a lot to digest in this 92-page report, but the one big take-away I get is how very, very different these “United” States are in children’s coverage. For the one-third of kids that depend on Medicaid and CHIP, their access to our nation’s healthcare pie depends entirely on where they live.
Here are just a few examples:
- Cost of a preferred name brand drug: Texas, $25; Utah, 25% of cost, Georgia, free.
- Cost of non-preventive doctor visit: Texas, $12, Maryland, free; Illinois, $5.
- Enrollment fees for CHIP: Texas $35 to $50, depending on income; Kentucky, none; New Jersey, none up to 201% of poverty, then $40.50. But, New Jersey also lets families up to 351% of poverty buy CHIP for $134.50.
- Length of time a child must be uninured befor enrolling in CHIP: Texas, 3 months; Idaho, 6 months; Hawaii, none.
This report lays out probably a hundred or more different variables in the eligibility, enrollment, renewal, and cost-sharing approaches that states can take for Medicaid and CHIP. And, I’ll bet no two states are alike. They’ve each developed their own synchronic concoction — a mixture that they believe will work best for kids — or if you’re cynical, what taxpayers have decided they’ll spend on kids’ health.
But there was one thing ALL 50 states had in common between 2010 and 2012. Even as our nation went through the worst recession in a quarter-century, states did not take draconian measures to cut kids from Medicaid.
Oh, many wanted to. Oh how they wailed! But, it was against the law. The Affordable Care Act, also known as Obamacare, said that if your state receives Medicaid funding, your state must maintain eligibility, enrollment, and renewal policies that were in place as of March 23, 2010 (when the law was enacted).
For that, we should be thankful. It could have been much, much worse.
