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More than 6 in 10 uninsured children are eligible for state coverage

State

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Percent of uninsured children (age 0-18), 2004/2005

Alabama

5.5%

Alaska

9.3%

Arizona

15.9%

Arkansas

9.4%

California

13.2%

Colorado

14.2%

Connecticut

7.8%

Delaware

11.8%

Florida

16.8%

Georgia

11.7%

Hawaii

4.8%

Idaho

10.6%

Illinois

10.8%

Indiana

9.5%

Iowa

6.1%

Kansas

6.5%

Kentucky

7.8%

Louisiana

8.2%

Maine

6.5%

Maryland

8.9%

Massachusetts

5.2%

Michigan

5.8%

Minnesota

6.2%

Mississippi

12.9%

Missouri

7.9%

Montana

14.1%

Nebraska

5.8%

Nevada

15.7%

New Hampshire

5.9%

New Jersey

10.5%

New Mexico

17.6%

New York

7.6%

North Carolina

11.4%

North Dakota

9.1%

Ohio

8.1%

Oklahoma

14.1%

Oregon

10.8%

Pennsylvania

8.5%

Rhode Island

7.4%

South Carolina

9.3%

South Dakota

8.7%

Tennessee

9.4%

Texas

20.0%

Utah

11.7%

Vermont

5.7%

Virginia

8.3%

Washington

7.8%

Washington D.C.

7.2%

West Virginia

8.4%

Wisconsin

6.3%

Wyoming

10.0

United States

11.0%

Source: Robert Wood Johnson Foundation

Of the 47 million uninsured Americans, about 8.7 million are children, according to the U.S. Census Bureau. Sadly, many of these children could be insured if they were enrolled in the State Children's Health Insurance Program (SCHIP) or Medicaid program for which they're eligible: More than six in 10 uninsured children who qualify for SCHIP or Medicaid are not enrolled, according to a 2007 report in Health Affairs.

SCHIP programs provide health insurance for children to low-income families who don't qualify for Medicaid and can't afford private health insurance. Some states have been able to expand SCHIP to also cover pregnant women and certain other adults in an attempt to further reduce their uninsured populations.

Since its inception in 1997, SCHIP has made significant inroads: The percentage of uninsured children has dropped by 24 percent. But there's still much to be done, both in getting the word out about SCHIP to families with eligible children and finding new ways to expand coverage.

Health insurance coverage is vitally important for children, and going without it can have long-term consequences. The Robert Wood Johnson Foundation says that uninsured children are more than three times less likely than insured children to visit a doctor in the course of a year (10 percent for insured children versus 33 percent for uninsured children).

Further, more than half (54 percent) of all uninsured children did not have a "well-child" checkup in the past year — more than double the rate of children with insurance (25 percent), according to analysis of 2006 data.

Children's coverage varies by race and ethnicity, according 2004/2005 data from the University of Minnesota School of Public Health of uninsured kids age 0 to 18:

  • 21.6 percent of Hispanic children are uninsured.
  • 11.8 percent of Black children are uninsured.
  • 11.4 percent of other ethnic group children are uninsured.
  • 7.2 percent of White children are uninsured.

In recent years states have ramped up their outreach programs and simplified the SCHIP application process in order to encourage applicants. What about the more than six in 10 children who remain uninsured but eligible?

According to a November 2007 article in the Journal of Policy Analysis and Management, SCHIPs are more successful at covering eligible families when the programs remove asset tests, make applications and renewals easier, provide continuous coverage during the year without monthly income verification, and offer parent benefits. On the other hand, mandated waiting periods for coverage lowered "take-up" rates. Also, variations in state outreach programs can mean a difference of 25 percent in take-up rates.

A September 2007 report from The Urban Institute, titled "Eligible but Not Enrolled: How SCHIP Reauthorization Can Help," says that SCHIP and Medicaid should borrow strategies from other programs in order to increase their coverage of those eligible. The report recommends ideas such as:

  • "Automatic enrollment" without forms to fill in, such as Medicare Part B's default enrollment of seniors unless they opt out.
  • "Express lane" eligibility, where states can grant coverage based on the applicant's eligibility for other programs.

SCHIP will need long-term funding in order to continue to help children and expand coverage, which depends on Congressional support. According to an August 2007 poll by the Robert Wood Johnson Foundation, 86 percent of voters say they support reauthorizing SCHIP and 63 percent say they support expanding SCHIP's budget by an additional $35 billion over five years in order to cover more children. The U.S. Senate and House of Representatives approved bills expanding SCHIP in 2007. President Bush has said he would veto any expansion.

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