• examine the extent of health insurance coverage of children,
  • analyze evidence on the relationship between health insurance coverage and children's access to health care,
  • identify safety net programs (e.g., community health centers, children's hospitals, and public health departments) that affect the degree of access children have to health care;
  • examine available evidence on trends in the magnitude or availability of safety net programs, and
  • consider the effects of changes in those programs on children's access to health care.

The Committee on Children, Health Insurance, and Access to Care included 14 individuals with expertise in health care financing and delivery. Collectively, these individuals had expertise in private insurance, managed care, Medicaid, and other public programs; health care delivery, including primary and specialty care in pediatrics and adult populations; health care policy, including legislative policy, regulation, health law, and health economics; epidemiology; and health services research.

The committee met three times between March and June 1997 and convened a public workshop in June 1997. Appendix C presents the workshop's agenda and participants.

The committee met again in January 1998 to discuss the new SCHIP program. The committee's recommendations about the SCHIP program are presented in a separate report, Systems of Accountability: Implementing Children's Health Insurance Programs (IOM, 1998).

To increase the input from a variety of stakeholders, the committee formed a liaison panel with nearly 200 representatives of national associations, provider groups, children's advocacy organizations, health policy organizations, and state and federal government agencies (see Appendix D). Members of the liaison panel were invited to make presentations at the public workshop and to provide written testimony and other materials for the committee's consideration.

Given the budget agreement, the challenge now is how to find political consensus on solutions, principally involving federal and state governments. So the challenge has shifted from where it was earlier this year, which was whether or not to take action, to how to take action.

Kathleen Means

Health Care Leadership Council, Washington, DC

Public Workshop, June 2, 1997

The Policy Context

The timing of this study presented an unusual set of challenges. The committee's deliberations took place over several months when children's health insurance and access were being debated by the U.S. Congress, the states, and the American public (see Box 1.2). At the beginning of the study, there seemed to be widespread support for incremental steps to reduce the number of uninsured children, building on activities that were already under way in several states.

During the course of the study, both political parties and the Clinton Administration presented a variety of proposals, including Medicaid expansions, block grants, vouchers, refundable tax credits for families, a tax credit for all children, family Medical Savings Accounts, and a new Children's Health Trust Fund. It was unclear what, if any, national legislative approach would be taken until Congress passed the Balanced Budget Act of 1997 in August, with its provisions for a flexible new program for states to expand children's health insurance (SCHIP) (see Box 1.1).

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