Health Insurance for Children

Children are among the most vulnerable of our citizens. They will supply the work and creativity that will drive this nation into the future. We especially need to be good to them since they will choose our nursing homes. Despite their parents’ strengths or failings, children cannot be blamed nor can responsibility for healthcare fall on their fragile shoulders. So how do we provide them with cost-effective, quality care? The adoption of universal health insurance would obviously ensure that all children would receive the highest quality, cost-effective, and timely healthcare.

However, while awaiting the adoption of a truly universal health insurance program, I suggest all children be covered by Medicare until their 19th birthday (this allows those who graduate from high school during their 18th year to have insurance while seeking employment). Those continuing their educations could continue coverage up to an additional four years at a modest cost, perhaps $100–$200 per half year. Current student health policies often pay out less than 40 cents on the dollar (an outrageous loss-ratio) and cap lifetime maximum coverage far below the rare but devastating health conditions that could befall a college-age student. Those with permanent disabilities or “uninsurable” chronic conditions already in the suggested child Medicare program would continue coverage for life. In addition, all maternity care, prenatal care, and delivery would be covered by Medicare.

Medicaid programs vary from state to state and, as entitlement programs, are often subject to budget cuts and complicated enrollment requirements. Because of low fee schedules, many doctors refuse care to Medicaid patients, resulting in many women not receiving proper prenatal care or deliveries. If the goal is to ensure the health of the child, this begins with prenatal care. Those with insurance would continue coverage for all other medical problems, except those involving maternity care. Medicare would be required by law to establish fee schedules based on those already existing, ensuring that all expectant mothers and children would have access to quality care. Parents would choose the child’s physicians and the expectant mother’s obstetrician. Physicians, especially pediatricians, family physicians, and obstetricians, would have simplified billing. With children and maternity care removed, employer-based insurance and individual policies would be less expensive.

A separate maternal and child division of Medicare would be established. For this division, there would be no deductibles or co-pays in order to ensure all receive the same quality of care and to avoid adding a cumbersome, costly bureaucracy to deal with those who can’t afford them. All federal monies now going to states for children and obstetric care will be earmarked for Medicare. Children on Medicaid cost less than one-fifth the cost of Medicare recipients. The current Medicare tax of 2.9 percent on wages could be raised to, perhaps, 3.9 percent, which together with federal Medicaid funds being rolled in should be more than adequate. The monies saved by the states’ Medicaid funds for children and obstetrics could be used to extend coverage to lower income adults currently earning above state thresholds.

Since, years ago, insurance companies and employers fought against mandating maternity care, they should easily accept this change. Many small companies offering health insurance to their employees can’t afford the rate increases that hiring someone with a costly disability and/or chronic condition would incur. Of course, those already insured by the private sector and who develop chronic conditions should retain their private coverage! By continuing coverage of children from the Medicare program with serious pre-existing conditions, we increase their opportunities to become productive, employed members of our communities. For others, we ensure a level of care that maintains the best quality of life possible for them. By extending Medicare, we would ensure quality medical care to the most vulnerable in our society, to those that private insurance companies least desire to cover and whom small employers cannot afford to. The lowered premiums for employer-based care would allow many employers who dropped coverage to once again offer it.

For this to work, Congress must redesign the Medicare Drug Benefit Program. The pharmaceutical industry over the past several decades has made average net profits of three times all other Fortune 500 companies. The legislation prohibited Medicare from bargaining for drug prices, something the VA, the military, Medicaid, and all private plans are allowed to do. Bargaining for prices comparable to those of others will ensure decent profits for the pharmaceutical companies, get rid of the absurd donut hole, and allow for complete coverage for children, pregnant women, those with disabilities and/or chronic conditions, and our seniors. In fact, covering this large group will ensure reasonable profits for the drug industry.

Children, senior citizens, and the disabled and/or chronically ill are among the most vulnerable in our society. In many cases, private insurance either will not cover them or does so reluctantly. Children are our future, regardless of their parent’s ability to provide insurance, guaranteeing them decent healthcare increases the probability they will become productive members of society. America is considered the land of opportunity. Health problems obviously diminish one’s ability to take advantage of this. Giving every child in America the best of care that we have to offer is the least we can do to give them a fighting chance. Providing coverage for those with disabilities and/or chronic illnesses is one of the hallmarks of a compassionate society and for some will allow them to join the workforce. This program will only continue coverage for those who were disabled/chronically ill as children in the program. Insurance companies are known for cherry-picking, i.e., avoiding those already ill. Employer-based premiums would be reduced so that more employers could offer health insurance. If the goal is the most cost-effective, equitable quality of care for the recipients, this proposal should merit serious consideration.