Health Care Reform for Children with Public Coverage: How Can Policymakers Maximize Gains and Prevent Harm?

Plans to overhaul our nation’s health care system are gaining momentum. Both houses of Congress are drafting health reform bills, and the president has identified health care reform as a top domestic policy priority for his first year in office. The broad goals of these health care reform proposals include moving the nation toward universal coverage, improving quality of care, and slowing the rate of health care cost growth. Detailed proposals have not yet been made public. However, available information suggests that reforms are likely to involve new subsidies for health insurance coverage, new enrollment approaches, some type of mandate for coverage and the creation of a health insurance exchange. A health insurance exchange would provide an organized health insurance market for the uninsured and others that would be more efficient and transparent relative to the current market for private insurance. Options under consideration that specifically pertain to children with public coverage include shifting individuals who currently have Medicaid and CHIP into commercial plans participating in the new exchange, perhaps with supplemental coverage from Medicaid or CHIP; increasing provider reimbursement rates under Medicaid and CHIP; and expanding Medicaid to additional parents and children. Summary