The argument to expand SCHIP

A research letter in the Journal of the American Medical Association evaluated data from the Medical Expenditure Panel Survey (a national survey on the costs and use of health care and health insurance) to uncover access to care issues among poor and near poor children.

Children that were uninsured were significantly more likely to receive no medical care in the preceding 12 months compared to insured children at every income level including those even > 400% federal poverty level (FPL). In multivariate analysis, this association held true up to 400% FPL (range of odds ratios for no medical care, 1.8-2.7)

Further illustrating this coverage crisis is evidence that uninsured children under 300% of the federal poverty level were significantly less likely to receive even basic preventive care such as well child visits and immunizations. Estimates from a 2008 Health Affairs article on health care costs by age group revealed per capita spending of only $2,650 in the pediatric population.

Disparities in access to medical care persist for ethnic and racial minorities such as Hispanic and Black children . Minority children continue to go without medical care significantly more often than their white counterparts up to income levels of 300% FPL (range of odds ratios for no medical care, 1.6-2.3).

Commentary:

Since the birth of SCHIP in 1997, the number of uninsured children has fallen from 10 million to 7 million in 2004. However, inflation of health care costs faster than incomes have put children in families making up to $63,081 (300% FPL for family of 4, year 2007) at severe risk for foregoing medical care. Minority children remain particularly vulnerable.

Current evidence suggests that SCHIP should at least be expanded to encompass all children at or below 300% FPL. Perhaps the new Congress will be bold enough to act swiftly not only to renew SCHIP  before it expires at the end of March 2009, but also to make it available to all children. If so, they will deliver on Barack Obama’s campaign promise of universal health care for America’s nearly 74 million children.

JAMA 2008; 300: 1882.

Health Affairs 2008; 27: w1.

by

Cedric K. Dark, MD, MPH