Health Care for All Our Children:
We Can Make It Happen

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No matter how hard parents try to keep their children healthy and safe, kids get sick and sometimes have accidents. Colds and fevers, rashes and falls are as much a part of a child's development as teething, crawling, walking, and talking. The best thing parents can do to ensure that their children stay healthy is to find and keep a regular health care provider who offers annual check-ups and vaccinations when a child is well and round-the-clock consulta tions and care when a child is sick.

In July 1996, with passage of the Act to Improve Health Care Access (Chapter 203), Massachusetts took a giant step toward providing all of its children with affordable, continuous health care by expanding two key programs: MassHealth (Medicaid) and the Children's Medical Security Plan (CMSP). Now no child in Massachusetts needs to go without health insurance. The challenge is to spread the word about these and other children's health care programs.

 

The Health Care Gap in Massachusetts

Although the Commonwealth's outstanding hospitals and medical schools attract people from all over the world, many Massachusetts families have not found their way to a regular source of health care. According to a 1995 survey by researchers based at the Harvard School of Public Health(1), 11.4% of Massachusetts citizens, or 683,000 people, had no health insurance. Included in that number were 160,000 children. Fewer than 1 in 5 of the parents of these children knew about the avail ability of Medicaid; less than 1 in 10 were aware of CMSP.

Consistent with these figures is a recent report from the Washington-based Center for Budget and Policy Priorities. Their research suggests that between 25 and 40% of Massachusetts children eligible for Medicaid were not enrolled during the same period.

Who is caught in this health care crunch? The largest group consists of children of working parents. Uninsured kids have moms and dads who do maintenance, repair, and construction, who work in restaurants, shops, and gas stations and in hair salons and day care centers. Some of these parents are self-employed; others put in long hours for modest wages. Many cannot afford private health insurance. Others are stuck in temporary or part-time jobs where no health coverage is available. The new law means that their kids can get health insurance--but only if they know that it is available.

A Profile of Uninsured Families in Massachusetts, 1995
Employed: 64%
Work 40 hours or more: 61%
Hold job for 5 years or more: 54%
Work in building or retail and food/beverage trades: 51%
Household income above poverty level: 65%
No coverage for more than a year: 70%
Aware of availability of Medicaid: 18%
Aware of availability of CMSP: 7%
Source: Harvard School of Public Health and Louis Harris Associates (1995), A Survey of the Health Insureance Status of Massachusetts Residents.

What It Means for Kids to Be Without Health Insurance

According to a recent Newsweek poll, nearly 51% of parents are concerned that their kids might have a serious accident or ill ness, and 35% worry about finding good health care for their kids. Parents want their children protected by vaccinations. They want help in managing their asthma and other chronic conditions. They want to know whether their children are developing nor mally, whether they need glasses, physical therapy, or counseling. To achieve those goals they need a strong, on-going relationship with a health care provider. For uninsured families this is very hard to achieve. Research has found that:⁽²⁾

• Although an annual physical checkup is recommended for one- to five-year-olds by the American Academy of Pediatrics, un insured children in this age group are three times more likely than insured kids to have had no doctor visit within the last year.

• Compared to insured children, uninsured kids are three times less likely to have received all of their immunizations.

• And even when they have usual sources of care, uninsured children are two to three times more likely than insured kids not to have continuous access to the same health care provider and twice as likely not to have access to 24-hour emergency care.

By the time many uninsured children arrive at the emer gency room, they may be so sick they need inpatient care. This is a costly outcomephysically dangerous for the child, emo tionally upsetting and time-consuming for the family, and a financial drain on everyoneand one that might have been prevented through the timely use of primary and preventive health care. For example, research has shown that every $1 spent on immunization for whooping cough saves $2 in other costs and every $1 spent for measles, mumps and rubella im munization saves $14 in other costs.⁽³⁾

Regular doctor visits are especially important in preventing serious episodes of asthma, bacterial pneumonia, and dehydration the most common causes of preventable hospitalizations among Massachusetts children, both insured and uninsured. ⁽⁴⁾

In 1995, charges for each preventable hospitalization for asthma averaged $3,061 per uninsured child, while charges for treatment of bacterial pneumonia and dehydration averaged $4,063 and $2,705, respectively. And national figures suggest that once they are in the hospital, these children may be short-changed in terms of quality of care. According to a recent report from the advocacy group Families USA, long-term uninsured children average only 42% of the inpatient hospital care days of insured children.

Massachusetts families have a choice of health care programs that offer their children access to the medical basics necessary for survival and good health. Each program has different eligibility guidelines and offers different services. The most widely available programs are the following.

• Children's Medical Security Plan (CMSP) is the fail-safe program: it offers a package of primary, pre ventive, and limited emergency health care to all uninsured children at no cost or with a monthly fee that depends on family income.
  

• MassHealth (Medicaid) has a richer package of benefits: it provides the most comprehensive set of health services to all poor children at little or no cost.
  

• CommonHealth is a MassHealth program for children with disabilities whose family income is higher than the standard eligibility guidelines.
  
  To sign up for the above three programs, call 1-800-909-2677
  
  

• Free Care covers hospital and health center services for all underinsured and uninsured children.
  

• Healthy Start covers pregnant teenagers and women who are not eligible for MassHealth.

This report was prepared by Massachusetts Kids Count, a statewide child data project of Massachusetts Citizens for Children and the Massachusetts Advocacy Center, funded by the Annie E. Casey Foundation.

(c)1997 Permission to reproduce text portions of this report is granted provided Massachusetts Kids Count 1997 is cited.

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NOTES:

1. Unless otherwise noted, data in this section from Harvard School of Public Health and Louis Harris Associates (1995), A Survey of the Health Insureance Status of Massachusetts Residents.
2. Data in this section from Newacheck et al. (1996), Pediatrics and Wood et al. (1990), Pediatrics.
3. Mann, C. (1994) Missed Opportunities: A Report on Children's Health Programs in Massachusetts. Boston: Massachusetts Law Reform Institute.
4. Data in this section from Massachusetts Department of Public Health and Massachusetts Rate Setting Commission.
5. Adapted from Massachusetts Human Services Coalition (1994), State House Watch.

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