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Annotated Bibliography

Stephanie Jamieson

3rd Year Law Student
The University of Dayton School of Law
Fall 1998


This annotated bibliography explores the issues, concerns, and steps taken toward insuring America's uninsured children. More than eight million of America's children are uninsured. Out of the eight million, several children qualify for some type of state aid but they are not aware of this fact. Many children reside in homes with at least one working parent and (mostly due to finance) they remain uninsured. 

Uninsured children are a national problem and it has recently become a national concern. On the local level, everyday citizens, doctors, and elected leaders are getting involved reforming the health care system. On a national level, the president is calling for and actively taking part in changing the health care system as it relates to children. America is finally realizing that something must be done to ensure adequate insurance coverage for our children. 

In recent years, several local, state, and federal programs have been enacted to help in insuring all of the children in the United States. Programs such as the State Children's Health Insurance Program (SHIP), the Children's Health Insurance Program (CHIP), and the expansion of Medicaid. 

Medicaid is a program designed to help the financially disadvantaged to receive medical care. However, many children were falling through the cracks of Medicaid. If their parents earned "too much" then the children could not receive Medicaid. Yet many times those parents did not earn enough to be able to afford private insurance. The government saw this as a national problem and took steps to remedy the situation. 

To handle this problem, the federal government allocated money to every state. With this money the states had the option to either expand their Medicaid system or create a new insurance plan for uninsured children. States have not taken this task lightly. States have expanded Medicaid to include more children, created CHIP and SHIP. The creation of CHIIP and SCHIP have made a big difference in the lives of many children. 

A high percentage of minority children are uninsured. Researchers have cited numerous reasons for the disparity. The most common reason deals with the issue of poverty. Many of America's minority children live in poverty. Therefore, private insurance is something that is not affordable. However, many children qualify for Medicaid and their parents do not even know it. Many minority children who qualify for Medicaid are going without health insurance. 

In conclusion, uninsured children have been a problem for long time. It has finally become a national priority. Government aid has helped to reduce the amount of uninsured children on a national and local level. However, many children remain uninsured. Local groups, children's advocates, and elected officials are helping to spread the word to people about the importance of children being medically insured. If things continue in the present manner, then by the year 2,000, the United States should see a significant drop in the number of its uninsured children.

The following articles are included in this bibliography:
Office of Health Policy: Chartbook on Children's Insurance Status

Poverty Matters: The Cost of Child Poverty in America

Rationing Without Justice: Children and the American Health System

Low Income Uninsured Children by State

Center on Budget and Policy Priorities: Millions of Uninsured Children are Eligible for Medicaid

MEPS Chartbook No. 1: Children's Health 1996

Children's Health 1996: MEPS Chartbook No. 1 (online)

Brookings Dialogue on Public Policy: Improving Access to Health Services for Children and Pregnant Women, Chap 3 The Economic and Budget Context

An Argument for the Inclusion of Children Without Medicare

14 Things You Should Know About the New Child Health Program

Managed Care For Children: Medicaid and the Uninsured

AHCPR Research on Children's Health

President Clinton Announces a Series of New Efforts to Enroll Uninsured Children in Health Insurance Programs

Kidcare and the Uninsured Child: Options for an Illinois Health Insurance Plan

Children's Defense Fund

State Children's Health Insurance Program

The Children's Health Insurance Program

Healthy Families State Plan Summary: Helping Uninsured Children

Medicaid Enrollment & Health Services Access by Latino Children in Inner-City Los Angeles

Access Barriers to Health Care for Latino Children

Managing Access: Extending Medicaid to Children Through School-Based HMO Coverage

Medicaid Managed Care: An Advocate's Guide for Protecting Children

Hospital Van Adds Dental Care - Service for Uninsured Local Children Giving Check-ups, Education

Stephanie Jamieson is a third-year law student at the University of Dayton School of Law in Dayton, Ohio. She graduated cum laude in 1996 from Mercer University in Macon, Georgia, with a B.A. degree in Sociology.


Department of Health and Human Services, Office of Health Policy: Chartbook on Children's Insurance Statushttp://aspe.os.dhhs.gov/health/chartbk/cover.htm,  (last visited Dec. 3, 1998) 

This comprehensive Chartbook examines the make-up and other characteristics of insured and uninsured children in the United States. The data in this Chartbook comes form the March 1996 Current Population Survey and it reflects the insurance status of children in 1995.(1) This thirty- four page report consists of charts, graphs, and tables that show the composition of insured and uninsured children (under the age of 18). 

The one age group that has the highest percentage of uninsured children is 18 years old.(2) Also, the largest ethnic group that represents uninsured children is Hispanics.(3)The chart also shows that many uninsured kids live with at least one adult worker with a full or part-time job (87%).(4) It amazes me to see that working parents are (in large numbers) unable to afford private insurance for their children. The majority of children who have two working parents are usually insured. What does this say about the state of our country in which people can wake up every morning, go to work, and not be able to afford private insurance for their children? Also, if the parent makes above a certain amount, then their children do not qualify for Medicaid. Fortunately changes are being made to try to remedy that problem. 

Arloc Sherman, Poverty Matters: The Cost of Child Poverty in America 
http://www.childrendefense.org/fairstart_povmat.html, (last visited Dec. 1, 1998)

This thirty-six-page article focused on the effects of poverty on children and proposes possible methods to ending child poverty. However, the article fails to focus directly on the issue of uninsured children in poverty adequately. This kind of surprised me. However, indirectly, the article did note the lack of adequate health care the children in poverty received.

I found the snip-its of people's life stories very interesting. This helps to put the article into perspective and aids the reader in seeing that this article is dealing with real people and real lives. Also, the article addressed the cycle of inadequate health care of children in poverty. It noted inadequate prenatal care and then the eventual inadequate health/medical care of the child due to lack of money. Reports have continuously shown that children in poverty lack adequate health insurance. Medicaid is there to help. However, it is unable to reach every child either because the parents do not know their children qualify for Medicaid or because the parents earn too much to qualify for Medicaid. More programs are being created so that when children are moved out of poverty status (in which they received Medicaid) they would still qualify for insurance if their parents do not earn enough to afford private insurance. The new plans have been created because the system would be working backwards to guarantee children insurance if they are "poor enough" but not guarantee insurance to children who are not "rich enough" to afford private insurance and "not poor enough" to receive Medicaid. 

Sara Rosenbaum, Rationing Without Justice: Children and The American Health System, 140 U. Pa. L. Rev. 1895 (May 1992) 

This commentary reviewed the health status of children and presented data on children's insurance coverage and access to health services. There is a high likelihood that children in poverty lack health insurance. Children's access to health care is highly associated with health insurance coverage, which many children do not have. In 1990, the amount of uninsured children would have surpassed 18 million had it not been for Medicaid.(5)

In 1990, the majority of uninsured children were Black and Latino.(6) In 1990, 12.9% of children under age 18 were uninsured, out of that 12.5% were White, 14.4% were Black, and an alarming 28.3% were Latino.(7) Poverty plays a big role in children being uninsured or inadequately insured. Steps are being taken to improve the conditions of uninsured children in poverty. Often, children are uninsured because their parent/s make too much money to qualify as living in poverty. However, the parents then usually do not earn enough to afford health care. I believe many Blacks and Latinos fall into that category of the working poor. That would help to explain the high level of children of color who are uninsured yet have parents that work.

U.S. Census Bureau, Low Income Uninsured Children by State,
http://blue.census.gov/hhes/hlthins/lowinckid.html, (last visited Dec. 3, 1998) 

The United States Census Bureau has published on the Internet the national statistics of children on poverty and uninsured children in poverty. The statistics reflect the number of children under the age of 19 who are at or 200% below the poverty level. Also, the statistics also reflect the percentage of children at or below 200% poverty level who are uninsured. The statistics reflect three year averages-- 1993-1995; 1994-1996; and 1995-1997. 

Most of the states have increased in the amount of children in poverty. Following suit, many states have also increased in the amount of uninsured children in poverty. The two states that remain on top in terms of the highest amount of children in poverty and uninsured are California and Texas.(8) It is interesting to note that California is one of the few states that have declined (thought not significantly) in the number of uninsured children at or below 200% poverty level. The decline is due to the fact that California has implemented many programs to deal with this problem. Other states could look at California as an example for other states to follow. 

Laura Summer, Sharon Parrott, and Cindy Mann, Center on Budget and Policy Priorities: Millions of Uninsured Children are Eligible for Medicaid, http://www.cbpp.org/mcaidprt.htm, (last visited Dec. 3, 1998)

This very helpful and comprehensive article focuses on under insured and uninsured children who are unknowingly eligible for Medicaid. Under federal law, a child under the age of six is eligible for Medicaid if his/her family's income is below 133% of the federal poverty line.(9) A child between the ages of 6 and 13 is also eligible if their family income is below 100% of the poverty line.(10) There is a plan for a new age group of children to be "phased in" so that all poor children under age 19 would be eligible for Medicaid by the year 2002.

There would be a drastic drop in the amount of uninsured children if more of them were enrolled the Medicaid program. This article would alleviate fears of working parents who may incorrectly assume that their job and income would disqualify their child from Medicaid. In 1994, nearly 80% of uninsured children (under age 11) who lived in families, that earned some type of income, were eligible for Medicaid but were not enrolled.(11) The authors suggest that new welfare laws, along with declining rates of employer-provided health care coverage for children, will lead to an increase of Medicaid eligible children not participating in the program.

This was a very in-depth article about the high rate of children that are unnecessarily uninsured. It explored the different effects that new welfare laws will have on Medicaid eligibility. Also, it provided statistics, state by state, to show how many of America's children are going without insurance or have inadequate insurance when there is good coverage available.

Weigers ME, Weinick RM, Cohen JW, MEPS Chartbook No. 1: Children's Health 1996(1998).

During the last decade, Medicaid has expanded to decrease the amount of uninsured children. However, there are still a large number of children who are uninsured. It is estimated that 15.4% of America's children were uninsured for the first half of 1996.(12)Number wise, that is nearly 11 million uninsured children.(13) It looks a lot differently when you put it in actual numbers versus percentage. Of those uninsured children, 90% lived in households with at least one working adult.(14) Out of the total amount of the uninsured children, Hispanics were the largest with 27.7%, next were Blacks with 17.6%, and Whites with 12.3%.(15) In terms of private insurance, 73.9% of White, 41.7% of Black, and 39.8% of Hispanic children had coverage.(16) But as to public health care plans, 13.8% of White, 32.5% of Black, and 40.8% of Hispanic children had coverage.(17) Looking at those statistics proves that more needs to be done to maintain and insure that adequate public insurance is always available for children. 

Approximately one out of every four children lives in a single family household.(18) Of those children in single households, 38.7% have private insurance; 41.5% have public insurance; and 19.8% are uninsured.(19) For children in two parent households, and alarming 73.7% have private insurance; 12.7% have public insurance; and 13.6% are uninsured.(20)

The employment status of parents also plays a role in the insurance coverage of children. A high percentage of insured children in America are covered by the jobs of their parent/s. Recent Medicaid expansion has had a great and positive impact on decreasing the number of uninsured children. In 1987, Medicaid covered 12.4% of children, and in 1996, 20.9% were covered.(21) Under the revised Medicaid program, in 1996, 9.4 million children that were eligible would not have been eligible in 1987.(22) It appears that the biggest barrier to children in not receiving health care is the inability of their parent/s to afford physician fees. 

Margaret E. Weigers, Ph.D., Robin M. Weinick, Ph.D., Joel W. Cohen, Ph.D.,Children's Health 1996: MEPS Chartbook No. 1 (online) http://www.ahcpr.gov/research/chrtbk/chrtbk1a.htm, (last visited Dec. 3, 1998)

This online version of the MEPS Chartbook is more helpful than the book version. Continuous updates are provided. The online version of this Chartbook was last updated March 1998. Also the online version has links that take the reader directly to other sites that provide more information about MEPS, survey methods, projected health spending, and many other links.

Joshua M. Wiener and Jeannie Engel, Brookings Dialogue on Public Policy: Improving Access to Health Services for Children and Pregnant Women, Chap 3 The Economic and Budget Context (1991)

Improving access the heath services for children will most likely call for tapping into new resources. Children's health initiatives are usually made to compete with other programs to obtain additional federal funding. Even if, as it has been suggested, federal taxes were raised, the extra money would most likely go to deficit reduction rather than children's health care policy or program. The author acknowledges that it is common for federal policy makers in one breath to voice their support for improving services for children but in another breath to deny the additional funds. There is usually a divide between who should take the bulk of improving children's health care services, the federal government or state government.

People who want government programs to improve access to health care for children are often split when it comes to saying which level of the government should be primarily responsible for expenditures -- federal, state, or local.(23) But despite that the authors are in accord that federal government should play a big role in providing health care for children because: 1. Millions of children are uninsured and improving health care access is a national problem; 2. Improving the problem is a matter of resource allocation and federal government better able to do so; 3. Federal mandates will get all states to comply and take part in proving health care access; and 4. Federal government could issue all people are equally eligible to take part in access to health care.(24) I agree with the authors. Federal government is better able to handle this issue. This is a national problem that will require national action (federal government ) and individual action (private organizations) to work together. But in the end the federal government is better equipped to set national laws o ensure equal access and it better able to fund any of these ventures. We spend money in the military so why not health. 

Raymond C. O'Brien, Rev., An Argument for the Inclusion of Children Without Medicare, 33 U. Louisville J. Fam. L. 567 (1995). 

Statistics have shown that too many of America's children are uninsured. This article suggests that if America wants healthy children then it should include children into the Medicare program. Medicare is a nationwide health insurance program designed for the elderly and certain disabled people. The author feels that Medicare should be expanded because Medicaid only covers a fraction of the nation's poor children. According to the article, Medicare would be better able to cover children because it is a more established program that has had success covering the elderly population.

Medicare was created to meet the needs of the elderly, and it can now also be used to meet the needs of children. The author feels that there are unique health care conditions that affect children and justifies their need to be included within the Medicare program. Unique health conditions that affect children are: 1. Discrimination; 2. Racism; and 3. Poverty.(25) One of the examples that the author uses to demonstrate these conditions is babies suffering with AIDS. The one group of children discriminated against the most, by the health care system, is children with AIDS.(26) Also, most of the children who end up untreated and dying from AIDS are infants of color.(27) The author feels that shows racial discrimination in the health care system. Under the condition of poverty, it has been seen statistically shown that poor children have the highest rate of being uninsured.

The author feels strongly about including children in the Medicare program if America wants to ensure healthier and medically insured children. I see a potential problem with inclusion of children within Medicare. I feel there would be concerns that diverting funds for children would take away from the original aim of Medicaid -- to assist the elderly. Also, I feel that the expansion of Medicaid over time will prove to be more successful than it has been in the past.

Children's Defense Fund, 14 Things You Should Know About the New Child Health Program,
(last visited Nov. 16, 1998) 

This article begins by telling the reader some basic facts about uninsured children. As of December 19, 1997, seven out of every ten people who lost health insurance daily were children.(28) The bulk of children who are uninsured fall into the gap of having parents who earn too much to quality for Medicaid but earn too little to afford private insurance. The new health legislation targets this group of children. This article informs the reader as to the amount of money available to states and what the states can do with the money. States have the ability to either expand their Medicaid coverage or create new child health programs. A state that plans to create their own health care system must follow a certain set of guidelines. Title XXI of the Social Security Act provides these guidelines.(29) This article explains the provisions of this statute in a way that allows the average reader to understand the guidelines. 

This article advocates using the federal funds further to expand the Medicaid program versus creating a new child health program. It is argued that it would make more economic sense to work with the already established system versus creating a new one that may cost more and may be no more effective. I agree with that assessment. Our nation is in too much of a critical state to try to take money to experiment with a new health program that has no guarantee of success. There is a greater guarantee of success by expanding our existing Medicaid coverage to include the children who fall in the gap of being too "wealthy" for Medicaid and too "poor" for private insurance. 

Harold E. Varmus, Managed Care For Children: Medicaid and the Uninsured http://www.nimh.nih.gov/research/prtyrpt/
managedcareforchildren.html, (last visited Dec. 3, 1998)

Part V of this article deals with managed care for children. The staff at the National Advisory Mental Health Council conducted an analysis on the cost of private managed behavioral health insurance plans that provide coverage to children. It was predicted that enactment of mental health parity legislation for children who are uninsured would push the existing trends toward greater management of mental health benefits.(30)Uninsured children have lower levels of mental service use than Medicaid children.(31)The study showed that the uninsured children's population more resembles the uninsured population versus the Medicaid population.(32) The author suggests a possible reason for the higher amount of Medicaid children receiving more mental health care versus uninsured children. It is proposed that compared to children who use Medicaid, uninsured families have experienced fewer of the social problems of poverty that would elevate the risk for mental disorders.(33)

This article poses a new way of looking at Medicaid coverage when it comes to covering children with mental conditions. I do not know if I agree with the assessment that children on Medicaid would have more mental problems because of their economic and social status in society. Instead it could simply be that people on Medicaid do not feel restricted when it comes to taking their children to a doctor even if the doctor is a psychiatrist or a psychologist.

AHCPR: Agency for Health Care Policy and Research, AHCPR Research on Children's Health, http://www.ahcpr.gov/research/chilres1.htm, (last visited Dec. 3, 1998) 

This site has links and information about children's health care insurance issues. On this site, a ten-page article also is discussing the Agency's research on children's health. 

Over the past quarter century, health services researchers compiled thorough data about the health of adults. The article calls for more research to be conducted on children concerning their own health issues in order to be able to receive adequate medical care to combat illnesses. More needs to be done to improve the quality of health care that children receive. The only way to do this is by conducting research and finding out what works and what does not.

This article includes a listing of numerous AHCPR sponsored research groups. A brief description of each of the researchers' work is also included. More specifically, researchers that study health care organizations' use, quality, access, and costs for children are in section two on pages two and three. Everything from race, ethnicity, economic level, to Medicaid program is researched to understand their role and effect of access of health care by children. This site and article were very helpful and informative. 

The White House Office of the Press Secretary, President Clinton Announces a Series of New Efforts to Enroll Uninsured Children in Health Insurance Programs
(last visited Dec. 3, 1998)

On February 19, 1998, at the Children's National Medical Center, President Clinton announced new efforts designed to enroll millions of uninsured children who are eligible for Medicaid or other state-based children's health programs but are not currently enrolled.(34) The efforts included: 1. Expansions under the children's Health Insurance Program (CHIP); 2. Presidential Directive to Federal Agencies; 3. Budget proposals to provide funding for children's healthy policy; and 4. A set of public/private initiatives designed in partnership with Governors, health care providers, children's health advocates, foundation, businesses and many others who are committed t providing coverage for our country's uninsured children.(35)

More than 10 million children are uninsured and over three million are unaware that their children qualify for Medicaid.(36) Several steps have been taken to show how serious President Clinton is about government taking more of an active role in enrolling uninsured children. An executive memo was sent to eight Federal Agencies that have jurisdiction over children's programs directing them to establish a multi-agency effort to enroll uninsured children. These agencies were instructed to: 1. Ensure that people are aware of health insurance programs that are available to children; 2. Develop children out reach programs to informal and assist people in insuring their children; and 3. Report, in 90 days, on their plans to assist on their enrollment of uninsured children.(37)The President's FY1999 budget proposed investing $900 million over five years in children's health outreach program. All of the private sector commitment ideas sound very good because the public needs to get more actively involved in solving this problem. However, everything looks good on paper. Only time will tell if the proposals are effectively carried out. 

Anna Wermuth, Kidcare and the Uninsured Child: Options for an Illinois HealthInsurance Plan, 29 Loy. U. Chi. L.J. 465 (Winter 1998) 

This comment deals with the advances in assuring health insurance for more children. Also, it looks at how Illinois has taken advantage of these national improvements. Currently, child advocates estimate that 10 million children in America are uninsured and the majority come from homes with working parents.(38) The parents either earn too much to qualify for Medicaid or do not earn enough to afford private insurance. Prior to August of 1997, little had been done to develop programs for the children who fell in the middle -- the "near poor" children.

On August 5, 1997, President Clinton passed the Balanced Budget Reconciliation Act of 1997 (BBA).(39) The BBA ensured that the federal government would allocate forty-eight billion dollars from the federal government to the State Children's Health Insurance Program (SCHIP).(40) Under the BBA, states had the option of: 1. Expanding Medicaid benefits to include more children; 2. Create a new State Child Insurance Health Plan (SCHIP); or 3. Provide health insurance to low-income children by combining the first and second approach.(41) I think option three could be the most effective way of ensuring that more uninsured children became insured. However, option three does include option two which is basically creating an insurance plan. If a state wishes to see immediate results taking time to create an insurance plan for children might not be the quickest route. Illinois elected to go with the first option, to expand Medicaid for uninsured children. This was the one method that Illinois felt, if used properly, could extend benefits to the state's 300,000 uninsured children.(42) Illinois thought that it was best to improve the old system versus creating a new one that had the potential to have the same problems as the original ("near poor" not being helped). 

Marian Wright Edelman, Children's Defense Fund
http://www.childrendefense.org/index.html, (last visited Nov. 16, 1998)

This is a very excellent and informative site. This comprehensive site it dedicated solely to improving the lives of children. Through this site Internet surfers will be able to access online information about advances in children's health care. 

There are links that will take readers to snapshots and reviews of every state's Medicaid and State insurance plan for children. The site is continuously expanding to include new data about the constantly expanding the national health care plan for uninsured children. There are also links that connect interested surfers to information on how to take an active role in assuring adequate insurance coverage of America's children. There is even a link that allows parents to sign their children up for free or low-cost health insurance.

American Academy of Pediatrics, State Children's Health Insurance Program {SCHIP} http://www.aap.org/advocacy/schip.htm
(last visited Sept. 23, 1998)

This website, created by the American Academy of Pediatrics, is very informative. The creators took the time to identify SCHIP (State Children's Health Insurance Program). This site has links to answer various possible questions about this new program to expand health care coverage for children. 

The links, include SCHIP: provisions; policy statements, implementation principles, and strategies; updates and coverage. Summaries are provided for better comprehension of the SCHIP links. The creators of this page have put together a very useful tool for people who wish to learn more about SCHIP. There is even a link that allows people to sign up and receive weekly updates of SCHIP via E-mail. The American Academy of Pediatrics has seriously taken on the task of actively trying to improve health care coverage for children with the creation of this website their work was not in vain because this site is very resourceful. 

National Conference of State Legislatures, The Children's Health Insurance Program (CHIP), 
http://www.ncsl.org/programs/health/chiphome.htm, (last visited Dec. 3, 1998)

This is a very helpful website for those who wish to find out more information about the CHIP program. The National Conference of State Legislatures created the site. As of, Dec. 3, 1998, this site has eight links that connect visitors to various CHIP information. There is a link to "CHIP chart" that takes a snapshot of 50 states' activities that include the latest legislation and HCFA approvals. Another link is a "CHIP - State Program Information" which shows summaries of state plans to improve children's health care and insurance access. The "CHIP and Cost-Sharing" link shows the cost sharing, in all sates, including co-payments, co-insurance, as well premiums. A "Chip and Dental Care" link provides information on states that have selected a non-Medicaid CHIP plan. The "CHIP Federal Funding and Statistics" link is a one page information chart. This site also provides a link to the "CHIP and Mental Health/Substance Abuse," which shows coverage for all fifty states concerning mental health and substance abuse. Another link is "CHIP and Outreach" which outlines state plans in conducting outreach programs. There is also a general link that connects to all other CHIP related website. 

I found this site to be very informative. Accessing this site can answer any possible questions that a person can have about the CHIP program. This website allows one to find out what is going on in his/her own state concerning improving access or assisting children to receive insurance and better health care. 

Healthy Families States Plan, Healthy Families State Plan Summary: Helping Uninsured Children,
http://www.dhs.cahwnet.gov/healthyfamilies/hfp/hffacts.htm, (last visited Dec. 3, 1998) 

California has the highest number of uninsured children and they have taken many steps to resolve this problem. There are many programs in California designed to improve health access for children. Some of the main beneficial programs are Healthy Start, the Health Insurance Plan of California (HIPC), and access for Infants and Mothers (AIM). Despite the existence of these programs, many do not qualify because their families earn either too much for Medi-Cal or too little for private insurance. So to remedy this problem, Healthy Families Program was created. 

Healthy Families Program provides health coverage to children by subsidizing private health insurance policies.(43) Under this program a child gets all the basic health care (medical, dental, hearing, and vision) needed for school and families have a choice of health plans. In order to qualify, family's income must be between 100 and 200 percent of the Federal Poverty Level; must not be eligible for free Medi-Cal coverage; and must not be covered by any form of insurance three months before eligibility.(44) Families are asked to pay a nominal fee in relation to the policy plan they choose, their income, and the amount of children enrolled.(45) This is an excellent program. By accessing this website, people can obtain more information about this program. Many more states need to create some sort of default insurance plan like the Healy Program. With the existence of more programs like that, the number of uninsured children should decrease with each new year. 

Neal Halfon et al., Medicaid Enrollment & Health Services Access by Latino Children in Inner-City Los Angeles, v. 277 JAMA 636 (1997) 

This study noted that in 1992, 25.6% of Latino children were uninsured in the United States compared to 9.8% of uninsured non-Hispanic White children and 13.6% of uninsured Black children.(46) The authors attribute a decrease in the amount of uninsured Latino children (in 1992) to the expansion of Medicaid eligibility standards. From August to December 1992, the authors conducted a survey of Latinos in two inner-city areas of Los Angeles (East and South Central Los Angeles).(47) A multistage cluster sampling design was used with a replicated quota sampling. The researchers obtained data from 817 eligible representative households. The study aimed to look at insured as well as uninsured children. Four categories of children were: 1. Uninsured since birth; 2. Continuously enrolled in Medi-Cal (California's Medicaid program) since birth; 3. Recently been insured as well as those who are not insured continuously; and 4. Private insurance coverage.(48) The study showed that the eligibility for Medicaid was greatest for children whose parents were illegal residents (due to greater poverty).(49) Also, children whose parents were United States citizens were more likely to have continuos Medicaid enrollment or private insurance.(50)

There was a strong correlation between children who received continuos medial care and who had continuos medical coverage. This study found, in contrast to other studies, that a parent's language or residency did not have a consistent impact on the measure of children's access to health care. The researchers, based on their findings, agree with recent literature that cite/site lower socio-economic status as well as lack of insurance coverage as barriers to children receiving adequate health care.

Glenn Flores et al., Access Barriers to Health Care for Latino Children, Amer. J. of Diseases of Children (1998). 

This study focused on identifying access to health care barriers for Latino children. A cross sectional survey was conducted on parents of 203 children who visited a pediatric Latino clinic at an inner-city hospital.(51) Parents were asked to name the greatest barrier to health care for their children. Language came in first by 26% and no medical insurance came in third with 13%.(52) From the group studied, 43% of the children were uninsured, more than half had some type of pubic insurance, and only 4% had private insurance.(53) The authors concluded that the greatest barrier to health care access for Latino children was language. Lack of health insurance came in fifth on the list.(54) One in five Latino parents said they did not bring their child to the clinic in the past because they could not afford it.(55) Some of the parents, of the uninsured children, worked but did not earn enough to pay for insurance but earned too much for their children to qualify for Medicaid. 

The authors acknowledged that there were limitations to their study. I believe these limitations had a great impact on the result of their study. I find it very hard to accept that language versus lack of insurance played a bigger role in children not receiving medical care. Even if every hospital, clinic, or doctor's office had someone who spoke Spanish, I think the number of kids not receiving medical care would still be large mostly due to lack of medical insurance. 

Robert Coulam et al., Managing Access: Extending Medicaid to Children Through School-Based HMO Coverage, v. 18 Health Care Financing Rev. 149 (Spring 1996). 

This study was conducted to see how a health maintenance organization (HMO) could be used to improve health care access of children. The researchers looked to examine the transition of children who had Medicaid for a short period of time but then go uninsured. The study found that almost 87% of children who are disenrolled from insurance plans are due to movement of children eligibility requirements.(56) Children usually age out of the plan criteria or graduate. The authors suggested that expanding the coverage eligibility (age and geography) would cut down on the amount of disenrollment of children. The article noted that with increased of coverage of children there has been a decrease in the use of ERs. The author found that to be a sign that health care access was improving because parents took their children to doctors in the initial stages of an illness versus rushing them to the ER at later (and more detrimental) stages of the illness. 

A multivariate analysis was used to compare access, utilization, and satisfaction between children who were enrolled in this study's demonstration and children in: Medicaid; private insurance; other types of insurance; and uninsured.(57) Overall, the results showed that uninsured children had better access to health care.(58) This was a quite good research report. It showed that by providing better coverage for children: 1. Their visits to the doctors will increase and 2. The ER will be used for emergency situations rather than for ordinary checkups for children. 

Donna Langill and Sunny Kim Dubois, Esq., Medicaid Managed Care: An Advocate'sGuide for Protecting Children, Chap 11 Ensuring Health Care for Children Through (1996).

The authors of this chapter suggest several helpful ways that advocates can get personally involved and help to improve health care system and access for children. The authors gathered their data from other advocates who used these techniques. An idea is for advocates to state data to document problems in Medicaid managed care programs. Ways to obtain such data are through informal requests of Freedom of Information Act requests.(59) States operating Medicaid programs require a finding of data to ensure meeting federal requirements. Advocates can gather their own data to document problems by using toll-free numbers, ombudsman programs, private surveys, or testing the system (example calling managed care plans; request appointment, see how long takes to see a plan physician).(60)

Another great idea was establishing a "Health Care for All's Helpline" a Boston based health advocacy organization, runs a Helpline to aid callers who have health care access and financing problems.(61) Establishing this elsewhere would help in remedying the problem of people whose children qualify for Medicaid but do not know it. This book and chapter provides phone numbers for people and organization who can be contacted regarding further information on establishing advocacy programs or locating advocacy programs/organizations within one's community. Within the chapter, along with the suggested ideas, personal stories were included to show the implementation of the plans and their levels of success. The stories are provided by advocates across the country who are sharing their successes in helping to improve health care access for children. This a very large but well organized and extremely helpful guide.

Sarah Jones, Hospital Van Adds Dental Care - Service for Uninsured Local Children Giving Check-ups, Education,
NEWdental26.html, (last visited Dec. 3, 1998)

This article shows that there are people in America who are trying to make a difference in the lives of uninsured children on a local level. Medically uninsured children are receiving free health care services from a mobile van that visits its neighboring communities. The van is staffed by physicians and nurses from the Lucile Salter Packard Children's Hospital.(62) Services that the van offers include fluoride treatments; dental checkups; referrals to dentists; immunizations; and physical checkups. The van visits a different community weekly. Uninsured children ranging from infancy to age 18 are treated by this van.

In the first year of the van's service, the physicians have helped 2,200 children.(63) The people providing this service are an example of something that local citizens can do to help children in their communities. This service should be looked at as what can be achieved by people giving of their time and hospital sharing some of their resources. Many people speak about the ill of uninsured children but very little take an active role in changing their condition. Well, the people at the Lucile Salter Children's Hospital and the Foothill College dental program are taking an active stance to improve the conditions of uninsured children. Others should follow their example. 


1. Department of Health and Human Services, Chartbook on Children's Insurance Status, 2 

2. Id at 2 

3. Id at 12 

4. Id at 5 

5. Sara Rosenbaum, 140 U. Pa. L. Rev. 1871 

6. Id at 1871 

7. Id at 1871 

8. U.S. Census Bureau, Low Income Uninsured Children by State, 1-4 

9. Laura Summer, Center on Budget and Policy Priorities, 1 

10. Id at 1 

11. Id at 2 

12. Margaret E. Weigers, MEPS Chartbook No. 1 Children's Health 1996: Health Insurance:Access to Care: Health Status, 6 

13. Id at 7 

14. Id at 7 

15. Id at 8 

16. Id at 8 

17. Id at 8 

18. Id at 9 

19. Id at 9 

20. Id at 9 

21. Id at 11 

22. Id at 11 

23. Joshua M. Wiener, Brookings Dialogue on Public Policy: Improving Access to HealthServices for Children and Pregnant Women, Ch 3, 17 

24. Id at 18 

25. Rev. Raymond C. O'Brien, 33 U. Louisville J. Fam. L. 574 

26. Id at 579 

27. Id at 606 

28. Children's Defense Fund, 14 Things You Should Know About the New Child Health Program, 2 

29. Id at 3 

30. National Institute of Mental Health, Managed Care for Children: Medicaid and the Uninsured, 1 

31. Id at 2 

32. Id at 2 

33. Id at 2 

34. White House, The White House: Office of the Press Secretary, 1 

35. Id at 1 

36. Id at 10 

37. Id at 2 

38. Anna Wermuth, 29 Loy. U. Chi. L. J. 465 

39. Id at 466 

40. Id at 466 

41. Id at 494 

42. Id at 526 

43. Healthy Families, Healthy Families State Plan Summary: Helping Uninsured Children 2 

44. Id at 3 

45. Id at 4 

46. Neal Halfon, 277 J. of the Amer. Med. Assoc. 2 

47. Id at 2 

48. Id at 3 

49. Id at 5 

50. Id at 5 

51. Glen Flores, Amer. J. of Diseases of Children 1 

52. Id at 1 

53. Id at 3 

54. Id at 6,7 

55. Id at 6 

56. Robert F. Coulam, 18 Health Care Financing Rev. 8 

57. Id at 11 

58. Id at 14 

59. Donna Langill, Medicaid Managed Care: An Advocates Guide for Protecting Children, Ch 11, 3 

60. Id at 5,6 

61. Id at 8 

62. Stanford Daily, Hospital Van Adds Dental Care-Service for Uninsured Local Children Giving Check-Ups, Education, 1 

63. Id at 1

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Professor Vernellia R. Randall
Institute on Race, Health Care and the Law
The University of Dayton School of Law
300 College Park 
Dayton, OH 45469-2772
Email: randall@udayton.edu


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