By Jocelyn Guyer

Even as the economy has fallen into an abyss and I find myself with distressing frequency discussing with people whether Levi Johnston really loves Bristol Palin, it turns out that there is actually some good news out there about health coverage.  Over the past year, 19 states have taken significant strides toward covering more children despite challenging fiscal times. At a National Health Policy Forum last week, three states explained their progress. And, no, the featured states weren’t the usual suspects like Massachusetts with its impressive, but so-complicated-that-you-need-an-MIT-degree-to-untangle-it system or Vermont with its population of 62 people and 4 dairy farms. They were Louisiana, Iowa, and Pennsylvania.

Here are the details of what they’ve done:

Louisiana has made significant progress in covering kids in recent years by expanding coverage through public programs (Medicaid and the State Children’s Health Insurance Program) and making it easier for families to sign up. It also has become the very best state in the country at “plugging the hole in the bucket.” While it is not uncommon for states to lose about one-third of their children when they come up for renewal, Louisiana loses fewer than one in a hundred kids – less than 1 percent.  It took leadership from the state’s political leaders and a commitment to changing the workplace culture of eligibility workers, but, otherwise, nothing too fancy.  The secrets?  Families no longer have to pull together copies of eight consecutive pay stubs when applying for coverage, they can renew by phone, and, whenever possible, the state uses information it already has on hand from other state programs to figure out when children remain eligible for coverage.

Pennsylvania also was in the spotlight for its Cover All Kids Initiative, which provides “all children” (undocumented children remain ineligible) with access to affordable, quality health care.  Under the initiative, children at lower income levels can qualify for a public program known as the Children’s Health Insurance Program (paying premiums at more moderate-income levels), while other families can buy in at full cost.

The “all kids have a place to go “strategy has been critical to the state’s success.  While some legislators were worried it might mean that Bill Gates would move to Pennsylvania and sign his kids up, he remains safely ensconced in Seattle. Only one percent of the kids who have signed in Pennsylvania are in the full cost part of the program.

As interestingly, by laying out the welcome mat and making sure that all families know they have a place to go, Pennsylvania signed up thousands of low-income kids who were already eligible for public coverage. Turns out it isn’t necessary to pick between focusing on covering the poorest kids in a state versus those in more moderate-income families. A “cover all kids” initiative helps both groups of families. 

Iowa is earlier in its process, but setting out to cover all children by expanding eligibility and making it easier for families to enroll in and keep coverage.  Its signed up two former Governors Vilsack (D) and Branstad (R) to work on the issues and is well on its way.  By July of 2009, it will have expanded coverage to more children and have a plan — developed through the collaboration of many diverse stakeholders — to get all children covered.   

If all of this cheerful news is making you want to turn on the TV news for a press conference with Treasury Secretary Paulson and Ben Bernanke, it is worth noting the dark spots raised by forum participants.  They are 1) the weak economy, 2) the Bush Administration’s decision to veto re-authorization of the State Children’s Health Insurance Program, and 3) an out-of-the-blue (the General Accounting Office and the Congressional Research Service say it’s illegal) Bush Administration policy designed to prevent states from expanding coverage to children in more moderate-income families.

Given these significant challenges, not all states can do it. Indeed, California recently decided to plug its budget hole in part by imposing more paperwork requirements on families seeking to keep coverage for their children, as Sarah Arnquist discussed earlier this year. Critics are warning that up to 250,000 children will lose coverage as a result. But, for now, at least, an impressive array of states is still moving forward, reflecting the powerful political and moral imperative to cover the nation’s children. Jocelyn Guyer is the deputy executive director at Georgetown University’s Center for
Children and Families (CCF) and a senior researcher at the Georgetown
University Health Policy Institute. This post represents her personal
opinion not that of the Institute.