Shawn Vestal: Uninsured kids, unhealthy politics in Idaho

Five years ago, a federal effort to enroll more children in the Children’s Health Insurance Program was launched.

This is apparently a point of debate in America, whether covering children with health insurance is a good or a bad thing. But there is no question that there were a lot of kids without health insurance: around 9.2 percent. There was no question that there were a lot of kids who qualified for the federal CHIP program who were, for some reason, not enrolled.

What happened then, in Washington and in Idaho, is a microcosm of the way that blue states and red states have approached health care. Washington has expanded health care programs for the poor. Idaho has done its best not to.

As a result, millions upon millions of dollars have come into Washington to provide medical care for the poor and near-poor and, especially, their kids. In Idaho, meanwhile – where a lawmaker once compared Obamacare to the Holocaust – millions and millions have not come, in what has become an annual show of penny wisdom and pound foolishness.

The latest excellent example arrived this week, with the announcement of the fifth and final year of CHIP bonuses. CHIP covers kids in families just above the qualifying level for Medicaid; how far above depends on each state. Washington’s approach is expansive, and it enrolls kids in its Apple Health for Kids program at free or subsidized rates at up to 300 percent of the poverty level, among the nation’s highest. In Idaho, the CHIP program is offered for those up to 185 percent of poverty level, among the lowest.

Each year since 2009, the federal government handed out bonuses to states that have made the most progress in enrolling eligible children in health insurance. Crucially, whether a state got any of this money had no bearing on whether the money was spent. Not taking the money to help poor kids didn’t do a thing for the federal budget deficit; it just ensured that other kids in other states got the benefits instead of yours.

For five straight years, Washington has earned bonuses totaling more than $67 million. Idaho got an estimated $3.8 million. (The Idaho grant award for 2013 was mistakenly set at $5.4 million; when it’s corrected, it is likely to be around $1 million, Department of Health and Welfare spokesman Tom Shanahan said.)

There’s a pretty simple reason: Idaho, at the direction of the Legislature, does not try to expand enrollments, do outreach or advertise, Shanahan said.

Washington’s rate of uninsured children has dropped below the national average of 7.2 percent to 5.8 percent, according to a Georgetown University Health Policy Institute report published in November. Idaho remains above the national average at 8.5 percent.

The general objections to public health insurance fall along budgetary and punitive lines, as well as a general and constant opposition to anything Obamacare-ish. Idaho deficit hawks have refrained from spending state money that would have been more than doubled by federal matches, to say nothing of helping residents. They have refused federal health coverage even when it will likely cost the state more for its own catastrophic health coverage. Gov. Butch Otter recently said he wouldn’t support Medicaid expansion this year in Idaho until it was reformed to force more personal responsibility onto the recipients, like penalizing patients who don’t lose weight.

There is, it seems, a constant fear that someone, somewhere, will get some health care they do not deserve.

Back in 1997, when the CHIP program was started, Washington was already starting its own program for children’s health insurance. In 2007, Apple Health for Kids was formed to expand coverage, including affordable and subsidized alternatives for people who aren’t quite in poverty. When the push to enroll more kids began, the state was well-positioned to do so and to take advantage of the bonuses, said Jon Gould, deputy director of the Children’s Alliance, a network of organizations that advocates for children in Washington.

Gould said some 60,000 children in Washington are still uninsured, and as the country’s massive changes in health care move forward, this piece of it will remain a challenge. Still, if you think providing health insurance for kids is a good idea, this effort has been effective, if incomplete.

“Despite the persistently high poverty rate for children (22.6 percent in 2012) and a weak economic recovery, children’s access to health coverage is improving steadily, thanks in large part to Medicaid and CHIP,” the Georgetown report concluded. “In contrast, even though the uninsured rate among nonelderly adults has declined since 2010, it is still almost three times the rate for children.”

And if you don’t think providing health insurance for kids is a good idea, take heart. There are plenty of places that are doing their best not to.