Background

More than 10 million children, one in seven, lack health insurance coverage, despite recent state and federal expansions in children's health programs. With 94% of uninsured children in families with incomes below 200% of the federal poverty level ($28,300 for a family of 3) eligible for health insurance through Medicaid or the State Children's Health Insurance Program (SCHIP), a principle focus in both programs this year will be to continue increasing the enrollment of those eligible children. In the aftermath of the 1996 welfare reform law, nearly 700,000 low-income people – 62% of them children – lost Medicaid coverage and became uninsured. That law also barred many legal immigrants from access to Medicaid coverage. The high-uninsured rate among children of non-citizen families is also a cause of concern. In 1999, the uninsured rate for citizen children living with non-citizen parents was 31.3%, up from 28.5% in 1995. Almost half of noncitizen children in families with incomes below the poverty line had no health insurance coverage in 1999.

State Children's Health Insurance Program: Created in 1997, SCHIP allows states to offer insurance coverage to children in low-income working families with incomes too high to qualify for Medicaid, but too low to afford private health insurance. Aggressive federal and state outreach efforts in 2000 resulted in a 70% increase in SCHIP enrollment. In fiscal year 2000 (ending September 30, 2000), 3.3 million low-income children now have health insurance coverage through SCHIP programs, compared to 2 million in 1999. Thirty six states now enroll children in families earning 200% of the federal poverty level. While SCHIP is not available for children eligible for Medicaid coverage, SCHIP screening can help identify Medicaid-eligible children and get them in that program. But despite these gains, there are still millions of uninsured children eligible for insurance through SCHIP or Medicaid who are not yet enrolled.

Medicaid: Federal law requires states to provide Medicaid eligibility to children under age 6 up to 133% of poverty; eligibility for children age 6 and over up to 100% of poverty is being phased in through 2002. But in many states, their parents are ineligible for Medicaid even if their income is below the poverty level. While some states have higher levels, on average only parents with incomes up to 41% of poverty were eligible for Medicaid coverage in 1999. But studies show that parents who are themselves eligible for coverage are more likely to enroll their eligible children. Three states – New Jersey, Rhode Island, and Wisconsin – were recently granted waivers under the SCHIP program to cover parents of SCHIP and Medicaid-eligible children.

Environmental Health: The unborn , infants and young children are uniquely vulnerable to environmental hazards and toxins. The lungs of newborns and infants are less developed and often lack the mature immune system defenses found in older children and adults. Children's active behavior patterns and certain aspects of the physiology lead to greater exposure to toxins and pollutants as compared to the average adult. Because children eat more food, drink more water, and breathe more air as a percentage of their body weight than adults, they receive a greater dose of whatever chemicals are present in food, water and air. In addition, the risk of poor children may be exacerbated by conditions such as the lack of adequate medical attention, insufficient nourishment, or crowded or unsanitary living conditions.

Asthma is the leading chronic illness among U.S. children. During the last two decades, asthma rates in the U.S. have doubled, and one-third of asthma sufferers are children. More people are hospitalized for asthma, and more are dying from asthma attacks – and the rates are higher for African-American children. Numerous studies indicate a link between asthma attacks and air pollution levels.

USCC Position

Children, born and unborn, are certainly among the weakest and most vulnerable members of our society. As Pope John Paul II said in Familiaris Consortio, "in the Christian view, our treatment of children becomes a measure of our fidelity to the Lord himself." [Putting Children and Families First, p.1.] While childhood should be a happy, secure, and safe time of growth and development, for too many children it is not. "The lives, dignity, rights and hopes of literally millions of children are at risk." [Putting Children and Families First, p.1.] Although there are many reason for society's failure to protect and nurture children, one of the reasons is our failure to assure access to affordable, comprehensive health care for all children. Every child, every person, has a basic right to adequate health care. [Health and Health Care: A Pastoral Letter of the American Catholic Bishops, p. 17.]

Action Requested

SCHIP and Medicaid: Urge Congress and state leaders to take steps to make sure low-income children have health care coverage, by:

• accelerating enrollment of children already participating in other income-tested publicly funded programs, e.g., WIC or school lunch
  
• eliminating asset tests
  
• redetermining eligibility only once a year
  
• simplifying and coordinating SCHIP and Medicaid application procedures, and allowing mail-in applications
  
• restoring eligibility to low-income legal immigrant children

Resources

Putting Children and Families First
Health and Health Care: A Pastoral Letter of the American Catholic Bishops
Renew the Earth
Making the CASE for Children's Health: Catholic Coalition for Children and A Safe Environment:

Websites: USCC: usccb.org CHA: chausa.org CCUSA: catholiccharitiesusa.org

For further information: Kathy Curran (ph) 202.541.3188, kcurran@usccb.org; Mark Gallagher (ph) 202.541.3142, mgallagher@usccb.org

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