It’s the website that ate Washington. You can’t open a newspaper, change a channel or walk into a congressional office in this town without someone analyzing or opining on the trials and tribulations of HealthCare.gov. And although there are real and important problems that must be addressed, they’re hardly unique — the federal Children’s Health Insurance Program and Medicare Part D also faced rocky starts. But the finger-pointing, blame-shifting and hand-wringing — not the website — may actually pose the bigger threat to children’s health.
The fact is that the website isn’t critical for children because the exchanges will not play a significant role in covering uninsured kids. The uninsured rate among children dropped again last year, even as the child poverty rate remained high, due overwhelmingly to CHIP and Medicaid, which protected kids from becoming uninsured in the wake of a recession that cost millions of families their employer-sponsored coverage.
CHIP and Medicaid, not exchanges, are the keys to covering most of the 6.3 million children who remain uninsured. In fact, research tells us two-thirds of those kids are already eligible for CHIP or Medicaid. Their parents just don’t know it.
The good news is that we know how to make significant progress. In short: Make health insurance more generally available and affordable; ferret out implementation problems quickly and work through or around them effectively; and do a great job spreading the word. Since CHIP launched in 1997, states have seen big coverage gains for children whenever they have expanded the program, assertively managed implementation problems and invested in effective outreach.
The combination creates a “welcome mat” effect that helps to reach the parents of children who have qualified all along and get those kids covered. We’ve seen it in red states like Texas, after the 2007 Legislature simplified CHIP enrollment and renewal, and in blue states like Oregon, after the state’s 2009 CHIP expansion. In these states and many others, clear and effective communications about new coverage options were essential in encouraging parents to enroll uninsured kids. The Affordable Care Act is an opportunity to lay out the CHIP and Medicaid welcome mat for uninsured kids on a national scale.
Unfortunately, the divisive politics dominating the public conversation about ACA are changing the message. Every time the parent of an uninsured child opens a newspaper or changes a channel, some politician or talking head is using the words “health care” and “failure” together. And if the message that comes through is that they need not apply, experience with state CHIP programs shows us they won’t.
And it’s not just talk. The toxic politics have inspired efforts to stop health care “navigators” from enrolling families and spawned tactics that have had a chilling effect on children’s hospitals, schools and others who might want to inform parents about health coverage options for their children.
There are things we can all do about it. We can start by working with the administration to fix the website and other problems that could slow ACA enrollment. As a new analysis by Stanford University researcher Gene Lewit observes, CHIP had its share of implementation problems too, and they slowed initial enrollment until policymakers got serious about fixing them in partnership with advocates and the public. Medicare Part D is another case in which a focus on fixing the problem resulted in a program now widely regarded as successful, despite some rough early going.
And as we did in both CHIP and Medicare Part D, we can deliver an honest, balanced message. There is room for a spirited public debate about the health care law, without the sort of hyperbole that tells parents they have no options. That isn’t true. And hyperpolitics and a buggy website are no reason for millions of children to remain uninsured.
Bruce Lesley is president of First Focus, a bipartisan children’s advocacy group.
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