Policy Paper

Health Equity for Impoverished Children

Hadia Haider

Dr. Hudson

PS 1010 – 511

30 March 2017
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THE PROBLEM

The issue of health inequity across all individuals in the United States is a multi-

faceted socio-economic problem and too wicked to solve all together. Instead, it must be

broken down and solved piece-by-piece. Such a portion of the overall problem of heath

inequity is the inability of children from lower-income families to gain access to health

care. This is due to the poor economic condition of the family as providing health care for

every child is admittedly expensive. In fact, 33.3% of the poor population in the United

States are children and more than half of them are not eligible for Medicaid because they

are either too far below the poverty line or their parents simply cannot prioritize health

care over the other obstacles the family may face (National Poverty Center 1). Thus, it is

clear that a large sector of the population is affected by the issue and requires action in

order to successfully solve it. Although this will not eliminate the overall problem of

health inequity, it will help put a dent in it and ensure more individuals are provided the

basic human right of health care.

THE SOLUTION

Fortunately, government and civic institutions have realized the importance of

providing health care to the future generation and have taken steps in order to maximize

the number of children with access. Christian Healthcare Ministries in Ohio has reached

out to individuals within the community to set up a system that helps families pay for

their health care costs (How It Works 2). In this way, the civic sphere is fighting the

problem of children not having access to health care because they are financially and
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emotionally supporting families so all of its members can receive the medical attention

that they may need. This organization is completely voluntary, but goes a long way in

medically helping the Christian children in Ohio. In addition, the government sphere has

created policies and set up centers for children at national, state, and local levels. IHA

Pediatric Healthcare in Canton, MI is a perfect example of the local government setting

up a place where pregnant women and children can seek medical attention for free

(Tochman 3). Similarly, the Michigan Department of Health & Human Services set up

MChild, which is a healthcare program for individuals under the age of 19. Although this

program does have a $10 charge per family no matter how many children are being

covered, it is still an effort to provide healthcare to children who may not have had it

otherwise (MDHHS Assistance Programs Medicaid 2). Lastly, the federal government

established the Children’s Health Insurance Program (CHIP) in 1997 under the

presidency of Bill Clinton. CHIP provided block grants for states to offer health

insurance to children who were not previously eligible for Medicaid and whose families

earned less than 200 percent of the federal poverty line. States who already have policies

set up for children from low-income families do not have to replace it with CHIP if an

individual family deems it unnecessary for themselves (Eligibility 2). In this way, both

the government and civic spheres have worked towards solving the health inequity of

children from low-income families at various levels.

The goal of the federal government’s policy specifically, was simply to provide

children previously not eligible for Medicaid the access to health care because of the

large population of individuals in such a situation. CHIP was intentionally designed to be

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easily applied for so that the greatest number of children can benefit. The federal

government gave grants to state governments meant specifically for the cause and

required for any leftover money to be returned at the end of each year (Eligibility 2). It

was up to the states to come up with the ideal method of distributing the grants out of

three options provided by the federal government: (1) expanding their existing Medicaid

programs to cover more children, (2) creating a new program to cover them, or (3) using

both Medicaid expansion and new programs.

However, like any other policy, CHIP met structural barriers in the process of its

establishment. After the problem was recognized and the agenda was set, officials

decided the best way to target children in need to healthcare was to base it on the income

of a family relative to the federal poverty line. This made it clear which families would

be eligible, but left the actual method of distributing the grants through insurance

companies to these select families was left vague. For example, would two families with

the same income but a different number of children receive equal aid or fair aid based on

that difference. Additionally, the implementation of the policy suffered

miscommunication and ambiguity; states found it difficult to enroll children into the

program despite it being designed for easy access (Obamacare and CHIP 1). By 2009, 7.5

million children remained uninsured (Obamacare and CHIP 2) because of these problems

in the unclear policy formulation and implementation.

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THE OUTCOME – A SUCCESS STORY

Fortunately, CHIP was able to overcome these structural barriers and provide

healthcare to children across the United States who previously were not eligible. In order

to surpass the problem in the formulation of the policy, Medicare advantage plans were

added to go hand-in-hand with CHIP that clarified the distribution of the grants and

allowed for families to receive the aid that they needed. The policy implementation issue

was founded on the lack of clear communication between the federal and state

governments. Some states previously had programs set up for children before CHIP was

formulated as seen with MChild. Therefore, states found it difficult to appropriately

educate the public about CHIP and implement it. However, over the years more and more

children were enrolled and the numbers grew exponentially. Today, 8 million children

across the nation are receiving health coverage through CHIP. Bruce Lesley, President of

the First Focus Campaign for Children, states, “CHIP stands out as a shining success

story,” in the history of healthcare policy in the United States with 92 percent of parents

of CHIP enrollees never or rarely having any problems paying their child’s medical care

(Lesley 3). Although it took some time for the policy to function effectively, it has gotten

there and helped children and families throughout the country.

Lessons that can be learned and applied to future policies under the umbrella of

the wicked problem of health inequity lie with identifying a small part of the overall

problem and pinpointing it to attract public opinion. Here, instead of trying to solve the

entire issue of health inequity, CHIP focused on children from lower-income families and

was able to lessen the problem of health inequity for a group of people who previously
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were not eligible for Medicaid. This goal of seeking out a portion of an overall problem is

vital in the success of a policy. In addition, the health care of children is more likely to

gain support of the entire public instead of perhaps an entire family. CHIP does not mean

that impoverished children are the only people who do not have access to health care; it

was simply an area that was likely to gain public opinion and thus be successful.

An aspect that should be emulated in future policies is allowing states to use a

federal policy in tangent to their pre-existing health policies. CHIP allowed individuals to

continue using programs set up by the state government if they desired, but also provided

the federal alternative. In this way, parents did not felt as though they still had a say in

how their medical insurance issue for their children gets paid for. Another aspect of CHIP

that should be emulated is the freedom given to the state. Although this did create

ambiguity and miscommunication, they can be avoided if boundaries were more clearly

set for the state governments.

On the other hand, CHIP took years to become effective and successful and did

not reach its full potential in the beginning of its adoption. This was primarily because the

states had difficulty reaching out to parents and educating the public about the policy.

Therefore, in future policies it is important to educate the public and spread the word in

the beginning so the policy is strong and effective from the get-go. CHIP also suffered in

the beginning because of miscommunication between the federal and state governments.

More clarity in the policy itself would help relieve this problem.
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Works Cited

"Eligibility." Medicaid.gov. N.p., n.d. Web. 30 Mar. 2017.

"How It Works." How It Works. N.p., n.d. Web. 30 Mar. 2017.

Lesley, Bruce. "CHIP: Don't Mess With Success." The Huffington Post.

TheHuffingtonPost.com, 05 May 2014. Web. 30 Mar. 2017.

"National Poverty Center | University of Michigan." RSS. N.p., n.d. Web. 30 Mar. 2017.

"ObamaCare and CHIP (Children's Health Insurance Program)." Obamacare Facts. N.p.,

n.d. Web. 30 Mar. 2017.

Tochman, Pete. "IHA Pediatric Healthcare - Canton." IHA. N.p., n.d. Web. 30 Mar. 2017.

"MDHHS Assistance Programs Medicaid." MDHHS - Health Care Programs Eligibility.

N.p., n.d. Web. 30 Mar. 2017.