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Almost 10 million American children--one in seven--have no health insurance year round, according to a report released last month by the Children's Defense Fund (CDF). Millions more lack health insurance for at least a few months a year.
That figure is up from 8.2 million in 1983, with ominous trends for the future, the CDF noted in the report, titled "The State of America's Children: Yearbook 1997," which documents the health and well-being of children in several areas.
"In 1993 more than three-quarters of employees at medium and large companies had to pay some or all of the cost of family health insurance provided through their employers," the CDF states. "In 1980 the proportion was less than half. If recent trends continue, by the year 2000, 40 percent of children will lack private coverage."
The CDF report cites some improvements in key areas of child health--especially gains in immunization rates and early prenatal care. In addition, the CDF notes that availability of health insurance and quality health care for children is variable across the states: a number of states are working toward expanding coverage of care and are improving children's health in several domains.
Mostly, however, the CDF documents a grim state of affairs for America's children, prompting CDF President Marian Wright Edelman to comment that "if America does not stand up now for its children, it will not stand strong in the new millennium."
The report also paints an especially harrowing portrait of the effect of the new welfare reform law on children (see story below).
APA President-elect Herbert Sacks, M.D., said children with psychiatric disorders are among the most severely affected by the problem of inadequate insurance coverage.
He added that one of his priority initiatives during his presidential year, which begins at the end of APA's annual meeting next month, will be to push for expanded health and mental health insurance coverage for children.
He noted that APA has been a member of the National Consortium for Children's Mental Health Services, a coalition of 23 organizations dedicated to expanding mental health coverage for children. The goals and principles of that consortium will receive priority attention during his presidential year, Sacks said.
Sacks said that one in four children lives below the federal poverty level, a fact that also has psychiatric and behavioral consequences for affected children.
"We know that many of these children have nutritional deficiencies," Sacks said. "Whatever emotional support they may receive from their families is neutralized by [nutritional] and other factors."
The problem of inadequate health coverage for children is a "Pandora's box" of larger social problems, Sacks concluded.
The CDF report states that if current trends continue, about 1.2 million children will lose private health insurance each year, with the result that approximately 12.6 million children will be without any health insurance--public or private--by the year 2000.
Moreover, the large majority of uninsured children have parents who are working. More than 63 percent of parents of uninsured children in 1995 were working full time, and more than 24 percent were working part time (see chart on page 36).
"By far, the majority of these children have parents who 'play by the rules,' " according to the CDF. "But the parents' incomes are too high to qualify for Medicaid, their jobs don't provide employer-paid insurance coverage for their families, and they cannot afford to pay the high cost of premiums for family health insurance coverage."
The percentage of children lacking health insurance varies greatly by state, the CDF reports.
The five states with the lowest percentage of uninsured children are Minnesota (6.7), Wisconsin (6.8), Vermont (7.5), Hawaii (8.0), and Michigan (8.3).
The five states with the highest percentage of uninsured children are New Mexico (24.7), Texas (22.7), Oklahoma (22.6), Arizona (20.2), and Louisiana (19.9).
A number of states made significant strides in expanding access to health care, the CDF says. The agency especially highighted initiatives in New York and Massachusetts.
"With Governor George E. Pataki taking the lead, New York extended to 13-18 year-olds its state-funded Child Health Plus Program, which helps working families buy private health insurance for children," the report notes. "The move will more than double program enrollment, from 104,000 children to 251,000 children over the next two to three years. The state also expanded covered benefits greatly, adding inpatient care."
Massachusetts, likewise, extended health coverage to at least 125,000 of the state's 160,000 previously uninsured children, the CDF reports.
The CDF also documents disturbing trends in others areas of children's health:
The advocacy group pledged to hold a series of "Stand for Children" rallies around the country on June 1 and to host a "virtual" Stand for Children Day on the Internet.
The overall impact of the welfare reform law signed by President Clinton last summer will be "devastating" to children, according to the Children's Defense Fund.
The child advocacy group's report titled "The State of America's Children: Yearbook 1997" focused on three areas of the welfare reform bill that will have an especially strong impact on children: the replacement of the Aid to Families with Dependent Children program, budget cuts in assistance programs, and the denial of public benefits to legal immigrants.
"The most sweeping measure in the law is the replacement of Aid to Families with Dependent Children (AFDC) with a new program called Temporary Assistance for Needy Families (TANF)," says the child advocacy agency.
These are the most basic of the changes in the new program:
The child advocacy group also noted that a second significant aspect of the welfare reform bill is the large budget cuts in assistance programs.
"Cuts included more than $27 billion over six years from the food stamp program, $7 billion from the children's portion of the Supplemental Security Income (SSI) program, and billions more from the Child and Adult Care Food Program, the Summer Food Service Program for children, the Title XX Social Services Block Grant, and Medicaid."
The CDF also notes in its report that most legal immigrants already in the country and most of those yet to enter the United States are cut off from eligibility for federal programs--including Supplemental Security Income and food stamps--and state-run programs, including TANF and Medicaid.
"The impact will be devastating," CDF says. "Hundreds of thousands of needy legal immigrants will lose life-sustaining nutrition, health, and income maintenance benefits. . . .
"If the grimness of this scenario is to be ameliorated at all, it will be because states base their TANF plans on what families and children really need--not on what appears to save the most money, or on myths about families on welfare," the CNF states.
(Psychiatric News, April 4, 1997)