BEFORE AL GORE became the father of the Internet, he invented a toll-free number for enrolling children in government-provided health insurance. Last month, at a press conference with the first lady, the vice president unveiled the number, which parents can call to get information on Medicaid and Kidcare, the child health-insurance entitlement that began in 1997. But Gore shouldn’t wait for the phone to ring. Despite his warning in 1996 that a child health care crisis of historic proportions was threatening our children’s very lives, the response to Kidcare has been underwhelming.
Back when the program was first proposed, the administration and the Children’s Defense Fund claimed that 10 million children in America had no health insurance. The situation was dire, justifying an expenditure of $ 40 billion over five years. Children with serious illnesses were going untreated because their parents couldn’t afford coverage. To drive the point home, the administration released a state-by-state breakdown of the number of kids who needed health care, and the White House vowed to sign up 5 million of them by 2000.
The 5 million target was supposed to give Gore an accomplishment to tout in his presidential run. The problem is, since Kidcare was enacted, fewer than 500,000 children have enrolled. Now the administration, desperate to reach a higher figure, has launched a $ 1 billion “outreach” effort to sign up more kids — whence the toll-free-number gimmick.
Chances are it won’t even come close. Nancy-Ann Min DeParle, the director of the Health Care Financing Administration, which releases federal funds to states once their Kidcare plans are approved in Washington, testified recently that the program was well on its way to the 5 million goal. But Min DeParle wasn’t convincing. She failed to provide Congress the total number of children enrolled to date, offering instead “unreviewed” estimates of enrollment upon full implementation of the program. And even that figure — about 2.5 million — was padded with children already enrolled in state health-insurance plans newly brought under the Kidcare umbrella.
Advocates claim it’s too early to tell how well the program will work. But experience in New York, Pennsylvania, and Florida, where pre-existing state health-insurance programs for kids are now receiving Kidcare funding, is not encouraging. According to the New York Daily News, New York state’s program has grown by barely 20,000 children since Kidcare funding kicked in, though advocates had claimed there was a large unmet need.
No wonder the administration wants to count new Medicaid enrollees toward its 5 million target. But here, too, it fudges the numbers for political purposes. Two years ago, the White House said 3 million eligible children were not signed up for Medicaid. The Health Care Financing Administration now puts the figure at 4.7 million. The Medicaid population did not increase by more than 50 percent in two years. Rather, the administration reclassified a portion of those without insurance as eligible for Medicaid.
The hope is that it will be faster and easier to enroll kids in Medicaid than to get new Kidcare programs up and running. (Medicaid also offers a richer benefits package.) Indeed from the outset, both the Children’s Defense Fund and the White House have pushed states to expand Medicaid eligibility rather than create new stand-alone programs providing private coverage. Of the 40 state plans approved so far, only 11 are entirely new, 20 are Medicaid expansions, and 9 combine new programs with Medicaid.
The current outreach effort is supposed to crank up enrollment, but that is wishful thinking. State Medicaid programs, whose funding rises with enrollment, already actively recruit participants. They use private organizations like foundations, children’s advocacy groups, health care providers, and businesses to educate parents and enroll children. And their experience is chastening. Even intensive door-to-door campaigns have failed to turn up more children. Pamphlets, phone calls, and home visits by nurses have succeeded about as well as doing nothing in persuading parents to avail themselves of free well-child screenings.
The fact is, Kidcare enrollment is going nowhere. The kids this initiative seeks to help simply do not exist. The administration and its allies overstated the number of children who were uninsured and at risk. Less than 4 percent of children under 18 (about 1.2 million) lack coverage for more than a year. The rest are covered by health insurance most of the time. Data from the National Health Interview Survey conducted by the Department of Health and Human Services show that even among families with incomes of $ 10,000 a year or less, 97 percent of children get all the care they need. Less than 2 percent cite lack of money or insurance as a reason for not getting care.
To some people, it is incomprehensible that anyone would pass up an entitlement. But parents may be passing up Kidcare because their children are generally healthy and they don’t believe government-provided health insurance will make much difference.
What’s more, those parents may be right. Strangely enough, there is no evidence that either Medicaid or private insurance makes kids healthier. A recent study by the National Bureau of Economic Research actually found that uninsured kids tended to be healthier than kids covered by Medicaid regardless of income or race. Notably, low-income black and Hispanic children had more illness after they started using Medicaid than before.
This is not a brief for cutting off Medicaid or Kidcare. Rather, it means that most kids are healthy to begin with and that their parents often prefer to obtain what care they need outside entitlement programs — at public-health clinics, for example, or from providers paid for out of pocket. Instead of trying to drag parents into Medicaid and Kidcare, why not simply give them the money to make their own choices? Why not make a credit or voucher available to those who need it to buy insurance, pay bills, or add children to their own coverage? Why not just cut taxes?
The answer has nothing to do with children’s health and everything to do with the fact that Al Gore and the Children’s Defense Fund need Kidcare more than kids do. There never was a real children’s health crisis, just a political benefit from talking about one.
Robert Goldberg is a senior research fellow in the Program on Medical Science and Society at the Ethics and Public Policy Center in Washington, D.C.
