In 2009, we watched a dire prediction come true. The California Legislature had short-funded the state’s Children’s Health Insurance Program, despite warnings by Children Now and others that the move would put children’s health at risk. Faced with a budget shortfall and no action in Sacramento to fill the gap, California’s children’s health agency imposed a waiting list.
Today, Congress faces a similar choice. Bills to fund the insurance program were recently introduced, and Congress must decide whether to act now to fund the program for four years at current levels – or delay action and risk letting funding expire Oct. 1.
As the saying goes, “Those who cannot remember the past are condemned to repeat it.” If California’s congressional delegation doesn’t remember one of our state’s biggest children’s health mistakes, Congress may soon repeat it, and kids all over America will pay the price.
The program is a state-federal partnership, and budget decisions in state capitals are being made now. In California, Gov. Jerry Brown proposed his budget in January and decisions will be made soon after he issues a revised budget in May. California’s budget process is relatively long; in states including Kentucky, Wyoming and Utah, the debate will be over before Easter.
The impact of the 2009 shortfall on children’s health was devastating. Newly eligible California kids were denied health insurance and told they would get coverage only if funding were restored. This was during the depths of the economic downturn; as parents lost health care coverage along with jobs, the need for children’s coverage increased.
The children’s health program wasn’t taking new clients, and the wait list grew. By the time funding was restored, more than 100,000 children were waiting. But ending the wait list didn’t solve the problem. Finding wait-listed families proved challenging, and a year later, enrollment was still down more than 50,000 kids.
The vast majority of the kids affected by the wait list were eligible for health coverage under California law. Nonetheless, they were uninsured for weeks or months for one reason: The Legislature waited too long to help them.
Without assurances from Washington, leaders in other states will be pressured to propose waiting lists, eligibility caps or even termination of their children’s health programs. The results, as California learned, will be thousands of children uninsured, forgoing needed care and incurring higher out-of-pocket costs. Every day Congress fails to act, the likelihood that we’ll repeat California’s mistake on a national scale increases.
Gov. Brown has already urged congressional committees to act early, and it’s not just Democrats supporting the program. The governors of Alabama, Michigan and Utah are but a few of the Republican governors urging quick action.
The program has been bipartisan from the start, created in 1997 by a Republican-controlled Congress and a Democratic president. A 2014 poll found strong support among Republicans, independents, Democrats and tea partyers.
The children’s insurance program earned this broad support because it works. The nonpartisan Annie E. Casey Foundation reports that though child poverty is much higher, the rate of uninsured American children is lower today than before the recession.
This should be a no-brainer. The program is a cost-effective response to an urgent problem facing real people in every state. Health coverage for one California child costs about $136 a month, compared to $785 for the average emergency room visit for children. Uninsured children are five times more likely to use the emergency room as a regular source of care. Doesn’t it make sense to invest in preventive care so families don’t end up with expensive ER visits?
Congress is looking for bipartisan successes to show it can work together. A smart investment in children’s health is a good place to start.
Lenny Mendonca is a director emeritus of McKinsey & Co. and founder and owner of the Half Moon Bay Brewing Co. Ted Lempert is president of Children Now, a national research and advocacy group based in Oakland.