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02/11/98 12:00 FAX 003 GRANTSCENE GRANTMAKERS IN HEALTH FALL 1997 EXPANDING HEALTH INSURANCE on developing and evaluating model programs to cover uninsured children. COVERAGE FOR CHILDREN With grant funds, we have supported forums on Capitol Hill to provide lawmakers with concrete information about designing programs to increase by Eugene M. Lewit, PhD coverage for children. We have devoted Director Research and Grants, Economics several issues of our journal, The Future of Children, to children's health care and The David and Lucile Packard Foundation health care reform and continued our coverage with several subsequent journal articles on the topic. We I mproving access to health coverage, large subsidies distribute The Future of Children free of care to assure that children may be necessary to charge to a large and diversified and pregnant women receive substantially increase audience of decision makers who have the care they need, when they coverage. Subsidies to an interest in children and their families. need it, has been a long- families for insurance We also have underwritten evaluations standing goal of the David coverage will most likely of model child health insurance pro- and Lucile Packard have to be provided by the public sector, although grams such as Child Health Plus in New Foundation's child health York State and California Kids in program. Although it cannot employment-based California. The evaluations are focused guarantee good health, health insurance, which plays a insurance is a major determi- key role in covering many primarily on the impact of the two nant of children's access to Lewit children, might be har- programs on children's utilization of health services, the quality of health care needed health care services. nessed to expand coverage received, their health status, and their Therefore, expanding health insurance for some of the uninsured. It must be noted, however, that the cost of insur- parents' satisfaction. The New York coverage for children is an important evaluation also looked at the impact of component of our health care access ance coverage is not the only barrier. It is estimated that as many as three the programs (which, at that time, focus. In 1995, 14 percent of children, 10 million uninsured children are in fact primarily provided coverage for eligible for coverage under Medicaid, the ambulatory care) on health care costs million children in the United States, did and whether coverage under the not have health insurance coverage; in federal-state health insurance program California, 1.6 million children under age for poor and low-income children and programs leads to a reduction in the use 18 were uninsured. In the two-year their families. The reasons why so many of high cost services such as emergency rooms and hospitalization. The Founda- period of 1995 through 1996, an esti- Medicaid-eligible children are not tion also has funded national and mated 23.1 million children, 33 percent enrolled in Medicaid and are uninsured California-based advocacy groups of all children, were without coverage are not well understood; they include the attempting to build support for ex- for at least one month. social stigma associated with Medicaid and other welfare-related programs, lack panded coverage. THE PACKARD FOUNDATION'S of awareness of eligibility by parents, AN IMPROVED OUTLOOK APPROACH administrative impediments to enroll- ment, and brief episodes of uninsurance The outlook for increasing health Foundation activities to help and eligibility associated with temporary insurance coverage for children changed increase health insurance coverage for parental unemployment or other dramatically in early August with children have used a number of strate- transitory life events. enactment of a new Title to the Social gies. Central to our approach is the The Packard Foundation's activities Security Act, Title XXI, the State recognition that, particularly for low- in this area have focused both on calling Children's Health Insurance Program and moderate-income families, since cost attention to the impact of a lack of (SCHIP). SCHIP provides states with can be a significant barrier to insurance insurance on children and families, and continued on page 3 Health Insurance for Children 1 "Take It Outside" Campaign 4 Health Care With Harm 6