Summary And Implications

During the past decade, states and private insurers have taken a variety of steps to extend health insurance coverage to low-income children. These strategies have included expansions of Medicaid, the development of state-sponsored programs involving subsidies for private coverage, state support for privately sponsored programs, and privately sponsored initiatives designed by private insurers and health plans. Although the majority of these programs have not been evaluated systematically, they have helped to reduce the number of uninsured children. Yet more than 11 million children are still uninsured.

With the new SCHIP legislation, some of these programs may be replicated, and several new and innovative programs also may be designed and implemented. One of the most fundamental questions for each of these programs concerns eligibility. As these and other state programs continue to be implemented and modified in the years ahead, it will be important to monitor the extent and impact of coverage as well as of coverage substitution (IOM, 1998).

Even with full subsidies for coverage, whether Medicaid or another type of program, there are still eligible children who do not enroll in any program. Much more needs to be learned about the ways in which families make decisions about health insurance coverage and about the financial and nonfinancial factors that influence their decisions about how to spend the family's financial resources. Along with more research about families, there is a need for better outreach strategies, more widespread and culturally sensitive public education efforts, streamlined enrollment processes, and other approaches that will support families and caretakers and help them to make the best decisions about their children's health care.

In the child health area, states have undertaken a variety of projects to improve their services and promote "best practices" in the healthy development of children. In recent years, states also have taken many steps to improve their accountability to their citizens, including providing better public information on the performance of state programs. SCHIP offers states flexibility in program design. In return for that flexibility in design, the committee believes that states have the responsibility to implement the program as fully as possible, to provide as much public information as possible about the program, and to coordinate SCHIP with other state and private programs in the states to maximize children's opportunities to receive access to care.


AAHP (American Association of Health Plans). 1997. AAHP Fact Sheets: Chronic Care. Washington, D.C.: AAHP.

AAHP. 1998. Health Insurance for Children. Washington, D.C.: AAHP.

Brown ER et al. 1997. 1.6 Million California Children Have No Health Insurance; Most Come from Families with at Least One Working Parent. []

Call KT, Lurie N, Jonk Y, Feldman R, Finch MD. 1997. Who is Still Uninsured in Minnesota? Lessons From State Reform Efforts. Journal of the American Medical Association 278(14):1191-1195.

Chollet DJ, Birnbaum ML, Sherman MJ. 1997. Deterring Crowd-Out in Public Insurance Programs: State Policies and Experience. Washington, D.C.: Alpha Center.

Commonwealth Fund. November 1996. Academic Health Centers: The Tenn Care Experience. Briefing Note from Karen Davis. New York: Commonwealth Fund.

Cutler DM, Gruber J. 1997. Medicaid and Private Insurance: Evidence and Implications. Health Affairs 16(1):194-200.

Dorn S, Teitelbaum M, Cortez, C. 1998. An Advocate's Tool Kit for the State Children's Health Insurance Program. Washington, D.C.: Children's Defense Fund.

Dubay L, Kenney G. 1997. Lessons From the Medicaid Expansions for Children and Pregnant Women: Implications for Current Policy. Statement for the United States House Committee on Ways and Means, Subcommittee on Health, Hearing on Children's Access to Health Coverage. April 8, 1997. []

Gauthier A, Schrodel SP. 1997. Expanding Children's Coverage: Lessons from State Initiatives in Health Care Reform. Washington, D.C.: Alpha Center.

The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement