Beneath the Surface: Barriers Threaten to Slow Progress on Expanding Health Coverage of Children and Families

Publication Date: October 2004

Publisher: Center on Budget and Policy Priorities (Washington, D.C.)

Author(s): Donna Cohen Ross; Laura Cox

Research Area: Health

Keywords: Health insurance; Economic projections; Income diversity; Economic inequality

Type: Report


Beset by a weak economy, rising health care costs and declining rates of employer-sponsored health coverage, the nation experienced an increase in the number of uninsured people for the third year in a row. According to the latest Census data, that number reached 45 million in 2003, the highest number on record. However, Medicaid and the State Children’s Health Insurance Program (SCHIP) continue to buffer this disheartening trend: The number of children with health coverage actually increased, since the growth in Medicaid and SCHIP coverage for children (4 million) more than offset the decline in employer-based coverage (2.5 million). Yet, as economic pressures continue to weigh heavily on state policymakers, these programs are being closely scrutinized for cost-savings. As a result, their capacity to continue to protect low-income children may be diminishing.

This report presents the findings of a survey of eligibility rules, enrollment and renewal procedures and cost-sharing policies in Medicaid and SCHIP for children and families in effect in the 50 states and the District of Columbia in July 2004, reflecting changes states implemented since April 2003. It is one of a series of surveys conducted over the last four years by the Center on Budget and Policy Priorities for the Kaiser Commission on Medicaid and the Uninsured.